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Specific SSRIs and birth defects: bayesian analysis to interpret new data in the context of previous reports
Open accessAbstract
OBJECTIVE: To follow up on previously reported associations between periconceptional use of selective serotonin reuptake inhibitors (SSRIs) and specific birth defects using an expanded dataset from the National Birth Defects Prevention Study. DESIGN: Bayesian analysis combining results from independent published analyses with data from a multicenter population based case-control study of birth defects. SETTING: 10 centers in the United States. PARTICIPANTS: 17,952 mothers of infants with birth defects and 9857 mothers of infants without birth defects, identified through birth certificates or birth hospitals, with estimated dates of delivery between 1997 and 2009. EXPOSURES: Citalopram, escitalopram, fluoxetine, paroxetine, or sertraline use in the month before through the third month of pregnancy. Posterior odds ratio estimates were adjusted to account for maternal race/ethnicity, education, smoking, and prepregnancy obesity. MAIN OUTCOME MEASURE: 14 birth defects categories that had associations with SSRIs reported in the literature. RESULTS: Sertraline was the most commonly reported SSRI, but none of the five previously reported birth defects associations with sertraline was confirmed. For nine previously reported associations between maternal SSRI use and birth defect in infants, findings were consistent with no association. High posterior odds ratios excluding the null value were observed for five birth defects with paroxetine (anencephaly 3.2, 95% credible interval 1.6 to 6.2; atrial septal defects 1.8, 1.1 to 3.0; right ventricular outflow tract obstruction defects 2.4, 1.4 to 3.9; gastroschisis 2.5, 1.2 to 4.8; and omphalocele 3.5, 1.3 to 8.0) and for two defects with fluoxetine (right ventricular outflow tract obstruction defects 2.0, 1.4 to 3.1 and craniosynostosis 1.9, 1.1 to 3.0). CONCLUSIONS: These data provide reassuring evidence for some SSRIs but suggest that some birth defects occur 2-3.5 times more frequently among the infants of women treated with paroxetine or fluoxetine early in pregnancy.
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“Additionally, the risk of birth defects seems to be increased in infants of women treated with some SSRIs during pregnancy.51”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [51]
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Rothman, K. J. (1990) · Epidemiology · doi:10.1097/00001648-199001000-00010 · Cited by 5,965
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Metadata
- Authors
- Reefhuis, J., Devine, O., Friedman, J. M., Louik, C., & Honein, M. A.
- Affiliations
- Centers for Disease Control and Prevention (US)
- University of British Columbia (CA)
- Boston University (US)
- Corresponding author
- Reefhuis, Jennita
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2015-07-08
- Volume
- 351
- Pages
- h3190
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC4496787
- OpenAlex
- W1930136637
- Cited by
- 161
- References
- 41
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 10 · 2021: 18 · 2020: 8 · 2019: 19 · 2018: 14 · 2017: 22 · 2016: 29 · 2015: 12
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- selective serotonin reuptake inhibitors, congenital malformations, paroxetine, fluoxetine, sertraline, citalopram, escitalopram, anencephaly, atrial septal defect, right ventricular outflow tract obstruction, gastroschisis, omphalocele, craniosynostosis, posterior odds ratio
- MeSH terms
- Abnormalities, Drug-Induced, Adult, Bayes Theorem, Depression, Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, United States, Odds Ratio, Case-Control Studies, Selective Serotonin Reuptake Inhibitors, Cardiovascular Abnormalities, Gastroschisis
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