title: Use of selective serotonin-reuptake inhibitors during pregnancy and the risk of clubfoot.
abstract: BACKGROUND
  Selective serotonin-reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. Previous studies have suggested that SSRIs may increase the risk of birth defects, including clubfoot. Using data from a population-based case-control study, we evaluated whether SSRI use increased the risk of clubfoot.
  
  
  METHODS
  Mothers were interviewed within 1 year after delivery about sociodemographic factors, pregnancy events, and exposures. They were specifically asked if they experienced depression or anxiety or if they took any of the following SSRIs: citalopram, escitalopram, fluvoxamine, paroxetine, sertraline, or fluoxetine. We used logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  We included a total of 622 clubfoot cases and 2002 nonmalformed controls born between 2006 and 2011 in Massachusetts, New York, and North Carolina. For the 2nd or 3rd lunar month of pregnancy (the relevant gestational period), SSRI use for a period of more than 30 days was higher in case mothers (5%) than control mothers (3%). After adjustment for maternal smoking and body mass index, the OR for any SSRI use and clubfoot was 1.8 (95% CI = 1.1-2.8). When individual SSRIs were examined, ORs were elevated for sertraline (1.6 [0.8-3.2]), paroxetine (9.2 [0.7-484.6]), and escitalopram (2.9 [1.1-7.2]).
  
  
  CONCLUSIONS
  Our data suggest an increased risk of clubfoot occurrence in relation to SSRI use. Drug-specific risks varied widely, and some estimates were unstable.
authors.affiliation: From the Slone Epidemiology Center, Boston University, Boston, MA.
authors.forename: Mahsa M
authors.initials: MM
authors.lastname: Yazdy
authors.forename: Allen A
authors.initials: AA
authors.lastname: Mitchell
authors.forename: Carol
authors.initials: C
authors.lastname: Louik
authors.forename: Martha M
authors.initials: MM
authors.lastname: Werler
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000928:Antidepressive Agents / Q000009:adverse effects*; D001007:Anxiety / Q000188:drug therapy*; D016022:Case-Control Studies; D003025:Clubfoot / Q000139:chemically induced* / Q000453:epidemiology*; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D008404:Massachusetts / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D009657:North Carolina / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors