title: Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports.
abstract: 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.
  
  
  METHODS
  Bayesian analysis combining results from independent published analyses with data from a multicenter population based case-control study of birth defects.
  
  
  METHODS
  10 centers in the United States.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA NZR5@cdc.gov.
authors.forename: Jennita
authors.initials: J
authors.lastname: Reefhuis
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Owen
authors.initials: O
authors.lastname: Devine
authors.affiliation: Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Friedman
authors.affiliation: Slone Epidemiology Center at Boston University, Boston, MA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Louik
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Honein
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology* / Q000517:prevention & control; D000328:Adult; D001499:Bayes Theorem; D018376:Cardiovascular Abnormalities / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D016022:Case-Control Studies; D003863:Depression / Q000188:drug therapy*; D005260:Female; D020139:Gastroschisis / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors