title: Sertraline use in the first trimester and risk of congenital anomalies: a systemic review and meta-analysis of cohort studies.
abstract: To perform a meta-analysis of available cohort studies on the association between sertraline use by pregnant women in the first trimester and the findings of congenital anomalies in infants.
  
  
  
  A comprehensive search of articles published from the index date up to 31stDecember 2015 investigating the aforementioned associations was conducted on PubMed and Web of Science. Mesh headings used included the terms "serotonin reuptake inhibitor," "sertraline," "congenital anomalies" and "obstetrical outcome."
  
  
  
  Twelve cohort studies that involved 6 468 241 pregnant women were identified. We summarized odds ratios (ORs) and 95% confidence intervals (CIs) of congenital anomalies using the random-effects model. Pregnant women who used sertraline in the first trimester had a statistically significant increased risk of infant cardiovascular-related malformations (OR = 1.36; 95% CI = 1.06-1.74; I2= 64.4%; n = 12) as well as atrial and/or ventricular septal defects (OR = 1.36, 95% CI = 1.06-1.76; I2= 62.2%; n = 8). Additionally, positive but nonsignificant associations between sertraline use and congenital anomalies of the nervous system (OR = 1.39; 95% CI = 0.83-2.32; I2= 0%; n = 5), digestive system (OR = 1.23; 95% CI = 0.76-1.98; I2= 0%; n = 5), eye, ear, face and neck (OR = 1.08; 95% CI = 0.33-3.55; I2= 32.1%; n = 3), urogenital system (OR = 1.03; 95% CI = 0.73-1.46; I2= 0%; n = 5), and musculoskeletal system (OR = 0.97; 95% CI = 0.69-1.36; I2= 0%; n = 5) were observed.
  
  
  
  This meta-analysis suggested that the use of sertraline use by pregnant women in the first trimester had an increased risk of cardiovascular-related malformations as well as atrial and/or ventricular septal defects in infants. Meanwhile, nonsignificant associations between sertraline use and other congenital anomalies were found. More cohort studies are warranted to provide detailed results of other congenital anomalies.
authors: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Zi-Qi
authors: ZQ
authors: Shen
authors: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Shan-Yan
authors: SY
authors: Gao
authors: International Education College, China Medical University, Shenyang, China.
authors: Shawn Xiang
authors: SX
authors: Li
authors: Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Tie-Ning
authors: TN
authors: Zhang
authors: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Cai-Xia
authors: CX
authors: Liu
authors: Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
authors: Hai-Chen
authors: HC
authors: Lv
authors: Department of Emergency, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Yuan
authors: Y
authors: Zhang
authors: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Ting-Ting
authors: TT
authors: Gong
authors: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Xin
authors: X
authors: Xu
authors: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Chao
authors: C
authors: Ji
authors: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Qi-Jun
authors: QJ
authors: Wu
authors: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
authors: Da
authors: D
authors: Li
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D020280:Sertraline / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
keywords: antidepressive agents; cohort studies; congenital anomalies; meta-analysis; pregnancy; sertraline