Association of citalopram with congenital anomalies: A meta-analysis

Kang, Hyun Hye; Ahn, Ki Hoon; Hong, Soon Cheol; Kwon, Bo Yong; Lee, Eun Hee; Lee, Ji Sung; Oh, Min Jeong; Kim, Hai Joong

doi:10.5468/ogs.2017.60.2.145

Cited by 9 publications

(6 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The observed increase in MCAs and CHD with maternal use of citalopram during the first trimester was inconsistent with all previous meta-analyses [ 11 , 12 , 14 , 15 ]. A recent meta-analysis by Kang and colleagues [ 11 ], including five cohort studies and one case-control study, reported no significant associations between exposure to citalopram and the risk of CHD during pregnancy. However, over twofold cohort studies were eligible for inclusion in our analysis.…”

Section: Discussioncontrasting

confidence: 98%

“…Furthermore, none of these meta-analyses attempted to comprehensively investigate the associations between the use of SSRIs and individual SSRIs and the risks of specific congenital malformations. Some of the previous meta-analyses [ 11 – 23 ] examined the risks of certain congenital malformations [overall major congenital anomalies (MCAs) and cardiac malformations] with maternal use of SSRIs and/or individual SSRIs. Other meta-analyses [ 24 – 28 ] examined the risks of specific (cardiac) malformations with the use of only one or two specific SSRIs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births

Gao

Sun

et al. 2018

BMC Med

114

View full text Add to dashboard Cite

BackgroundIn 2005, the FDA cautioned that exposure to paroxetine, a selective serotonin reuptake inhibitor (SSRI), during the first trimester of pregnancy may increase the risk of cardiac malformations. Since then, the association between maternal use of SSRIs during pregnancy and congenital malformations in infants has been the subject of much discussion and controversy. The aim of this study is to systematically review the associations between SSRIs use during early pregnancy and the risk of congenital malformations, with particular attention to the potential confounding by indication.MethodsThe study protocol was registered with PROSPERO (CRD42018088358). Cohort studies on congenital malformations in infants born to mothers with first-trimester exposure to SSRIs were identified via PubMed, Embase, Web of Science, and the Cochrane Library databases through 17 January 2018. Random-effects models were used to calculate summary relative risks (RRs).ResultsTwenty-nine cohort studies including 9,085,954 births were identified. Overall, use of SSRIs was associated with an increased risk of overall major congenital anomalies (MCAs, RR 1.11, 95% CI 1.03 to 1.19) and congenital heart defects (CHD, RR 1.24, 95% CI 1.11 to 1.37). No significantly increased risk was observed when restricted to women with a psychiatric diagnosis (MCAs, RR 1.04, 95% CI 0.95 to 1.13; CHD, RR 1.06, 95% CI 0.90 to 1.26). Similar significant associations were observed using maternal citalopram exposure (MCAs, RR 1.20, 95% CI 1.09 to 1.31; CHD, RR 1.24, 95% CI 1.02 to 1.51), fluoxetine (MCAs, RR 1.17, 95% CI 1.07 to 1.28; CHD, 1.30, 95% CI 1.12 to 1.53), and paroxetine (MCAs, RR 1.18, 95% CI 1.05 to 1.32; CHD, RR 1.17, 95% CI 0.97 to 1.41) and analyses restricted to using women with a psychiatric diagnosis were not statistically significant. Sertraline was associated with septal defects (RR 2.69, 95% CI 1.76 to 4.10), atrial septal defects (RR 2.07, 95% CI 1.26 to 3.39), and respiratory system defects (RR 2.65, 95% CI 1.32 to 5.32).ConclusionsThe evidence suggests a generally small risk of congenital malformations and argues against a substantial teratogenic effect of SSRIs. Caution is advisable in making decisions about whether to continue or stop treatment with SSRIs during pregnancy.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1193-5) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussioncontrasting

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births

Gao

Sun

et al. 2018

BMC Med

114

View full text Add to dashboard Cite

show abstract

“…Telmisartan was taken concomitantly with citalopram. From previous studies, therapeutic use of citalopram is not associated with major birth defects 13 .…”

Section: Discussionmentioning

confidence: 91%

Reliability of cardiovascular drug use in pregnancy with clinical pharmacology teratology risk analysis

Aykan

Ergün

2019

Cukurova Medical Journal

View full text Add to dashboard Cite

show abstract

“…We found 17 meta-analyses about the risk of MM or cardiac malformations (CM) after exposure to SSRI ( Table 1 ). The vast majority of them did not control for possible confounding by indication as follows: 8 meta-analyses evaluated MM risk, 5 of which resulted in significant risk [ 13 , 14 , 15 , 16 , 17 ] and 3 in non-significant risk [ 18 , 19 , 20 ]; 18 meta-analyses evaluated CM risk, 11 of which report significant risk [ 13 , 16 , 17 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], while 7 report non-significant CM risk [ 14 , 15 , 20 , 23 , 24 , 28 , 29 ]. Looking for meta-analyses that accounted for possible confounding by indication, we found only two studies [ 17 , 24 ], both of which resulted in a non-significant risk for congenital malformations overall.…”

Section: Resultsmentioning

confidence: 99%

Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders

Eleftheriou,

Zandonella Callegher,

Butera

et al. 2023

IJERPH

View full text Add to dashboard Cite

Introduction: The initiative of a consensus on the topic of antidepressant and anxiolytic drug use in pregnancy is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during pregnancy, and the data from the literature are complex and require expert judgment to draw clear conclusions. Methods: For the elaboration of the consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynecology, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynecologists, neonatologists) was first established to identify the needs underlying the consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the “Nominal Group Technique” with the help of a systematic review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document. Results: The following five areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders in pregnancy, identifying the risks associated with untreated maternal depression in pregnancy. (2) The assessment of the overall risk of malformations with the antidepressant and anxiolytic drugs used in pregnancy. (3) The evaluation of neonatal adaptation disorders in the offspring of pregnant antidepressant/anxiolytic-treated women. (4) The long-term outcome of infants’ cognitive development or behavior after in utero exposure to antidepressant/anxiolytic medicines. (5) The evaluation of pharmacological treatment of opioid-abusing pregnant women with depressive disorders. Conclusions: Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in pregnant women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment on the pregnancy and on the fetal outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.

show abstract

Association of citalopram with congenital anomalies: A meta-analysis

Cited by 9 publications

References 24 publications

Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births

Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births

Reliability of cardiovascular drug use in pregnancy with clinical pharmacology teratology risk analysis

Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders

Contact Info

Product

Resources

About