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Meta-Analysis
. 2017 Feb 21;7:43085.
doi: 10.1038/srep43085.

Use of Selective Serotonin-Reuptake Inhibitors in the First Trimester and Risk of Cardiovascular-Related Malformations: A Meta-Analysis of Cohort Studies

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Free PMC article
Meta-Analysis

Use of Selective Serotonin-Reuptake Inhibitors in the First Trimester and Risk of Cardiovascular-Related Malformations: A Meta-Analysis of Cohort Studies

Tie-Ning Zhang et al. Sci Rep. .
Free PMC article

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.

Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Flow-chart of study selection.
Figure 2
Figure 2. Forest plots of the relationship between SSRIs use and risk of cardiovascular related malformations.
Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% CIs; diamond indicates the summary relative risk with its 95% CI. RR: relative risk.
Figure 3
Figure 3. Forest plots of the relationship between SSRIs use and risk of septal defects.
Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% CIs; diamond indicates the summary relative risk with its 95% CI. ASD: atrial septal defect; RR: relative risk; VSD: ventricular septal defect.

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