title: Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: population based cohort study and sibling design.
abstract: OBJECTIVE
  To assess whether use of specific selective serotonin reuptake inhibitors (SSRIs) or venlafaxine in early pregnancy is associated with an increased risk of birth defects, with emphasis on cardiovascular birth defects even when accounting for lifestyle or other familial confounding.
  
  
  METHODS
  Multicountry population based cohort study, including sibling controlled design.
  
  
  METHODS
  Nordic population (Denmark, Finland, Iceland, Norway, and Sweden) identified from nationwide health registers at different periods in 1996-2010.
  
  
  METHODS
  The full study cohort included women giving birth to 2.3 million live singletons. The sibling cohort included 2288 singleton live births. The sibling controlled analyses included sibling pairs who were discordant for exposure to SSRIs or venlafaxine and birth defects.
  
  
  METHODS
  Prevalence of birth defects, including subtypes of cardiac defects. Odds ratio of birth defects from logistic and conditional logistic regression.
  
  
  RESULTS
  Among 36,772 infants exposed to any SSRI in early pregnancy, 3.7% (n=1357) had a birth defect compared with 3.1% of 2,266,875 unexposed infants, yielding a covariate adjusted odds ratio of 1.13 (95% confidence interval 1.06 to 1.20). In the sibling controlled analysis the adjusted odds ratio decreased to 1.06 (0.91 to 1.24). The odds ratios for any cardiac birth defect with use of any SSRI or venlafaxine were 1.15 (95% confidence interval 1.05 to 1.26) in the covariate adjusted analysis and 0.92 (0.72 to 1.17) in the sibling controlled analysis. For atrial and ventricular septal defects the covariate adjusted odds ratio was 1.17 (1.05 to 1.31). Exposure to any SSRI or venlafaxine increased the prevalence of right ventricular outflow tract obstruction defects, with a covariate adjusted odds ratio of 1.48 (1.15 to 1.89). In the sibling controlled analysis the adjusted odds ratio decreased to 0.56 (0.21 to 1.49) for any exposure to SSRIs or venlafaxine and right ventricular outflow tract obstruction defects.
  
  
  CONCLUSIONS
  In this large Nordic study no substantial increase was found in prevalence of overall cardiac birth defects among infants exposed to SSRIs or venlafaxine in utero. Although the prevalence of septal defects and right ventricular outflow tract defects was higher in exposed infants, the lack of an association in the sibling controlled analyses points against a teratogenic effect of these drugs.
authors.affiliation: Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, PB 4404 Nydalen, NO 0403 Oslo, Norway kari.furu@fhi.no.
authors.forename: Kari
authors.initials: K
authors.lastname: Furu
authors.affiliation: Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet Stockholm, Sweden.
authors.forename: Helle
authors.initials: H
authors.lastname: Kieler
authors.affiliation: Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Haglund
authors.affiliation: Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, PB 4404 Nydalen, NO 0403 Oslo, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Engeland
authors.affiliation: Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, PB 4404 Nydalen, NO 0403 Oslo, Norway.
authors.forename: Randi
authors.initials: R
authors.lastname: Selmer
authors.affiliation: Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet Stockholm, Sweden Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Stephansson
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Unnur Anna
authors.initials: UA
authors.lastname: Valdimarsdottir
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Helga
authors.initials: H
authors.lastname: Zoega
authors.affiliation: Department of Medical Genetics, University of Helsinki, Helsinki, Finland Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Miia
authors.initials: M
authors.lastname: Artama
authors.affiliation: THL National Institute for Health and Welfare, Helsinki, Finland Nordic School of Public Health, Gothenburg, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Teratology Information Service, HUSLAB and Helsinki University Central Hospital, Helsinki, Finland Department of Clinical Pharmacology, Helsinki University, Helsinki, Finland.
authors.forename: Heli
authors.initials: H
authors.lastname: Malm
authors.affiliation: Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Nørgaard
mesh_terms: D000328:Adult; D015331:Cohort Studies; D000075202:Contraindications; D003511:Cyclohexanols / Q000008:administration & dosage / Q000009:adverse effects*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006330:Heart Defects, Congenital / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000523:psychology; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D035781:Siblings; D000069470:Venlafaxine Hydrochloride
chemical_list: D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride