title: Use of selective serotonin-reuptake inhibitors in the first trimester and risk of cardiovascular-related malformations: a meta-analysis of cohort studies.
abstract: The relationship between selective serotonin-reuptake inhibitors (SSRIs) use during first trimester and cardiovascular-related malformations of infants is still uncertain. Therefore, we conducted this systematic review and meta-analysis to assess the aforementioned association. A systematic literature review identified studies for cohort studies about SSRIs use and cardiovascular-related malformations in PubMed and Web of Science. We summarized relative risk (RRs) and 95% confidence intervals (CIs) of cardiovascular-related malformations using random-effects model, and heterogeneity and publication-bias analyses were conducted. Eighteen studies met the inclusion criteria. Pregnant women who were exposed to SSRIs at any point during the first trimester had a statistically significant increased risk of infant cardiovascular-related malformations (RR = 1.26, 95%CI = 1.13-1.39), with moderate heterogeneity (I2= 53.6). The corresponding RR of atrial septal defects (ASD), ventricular septal defects (VSD), ASD and/or VSD was 2.06 (95%CI = 1.40-3.03, I2= 57.8), 1.15 (95%CI = 0.97-1.36; I2= 30.3), and 1.27 (95%CI = 1.14-1.42; I2= 40.0), respectively. No evidence of publication bias and significant heterogeneity between subgroups was detected by meta-regression analyses. In conclusion, SSRIs use of pregnant women during first trimester is associated with an increased risk of cardiovascular-related malformations of infants including septal defects. The safety of SSRIs use during first trimester should be discussed to pregnant women with depression.
authors.affiliation: Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Tie-Ning
authors.initials: TN
authors.lastname: Zhang
authors.affiliation: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Shan-Yan
authors.initials: SY
authors.lastname: Gao
authors.affiliation: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Zi-Qi
authors.initials: ZQ
authors.lastname: Shen
authors.affiliation: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Da
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Cai-Xia
authors.initials: CX
authors.lastname: Liu
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
authors.forename: Hai-Chen
authors.initials: HC
authors.lastname: Lv
authors.affiliation: Department of Emergency, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Gong
authors.affiliation: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ji
authors.affiliation: Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
authors.forename: Qi-Jun
authors.initials: QJ
authors.lastname: Wu
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D018376:Cardiovascular Abnormalities / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced* / Q000453:epidemiology; D011261:Pregnancy Trimester, First; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors