Escitalopram updated on 07-01-2025

Congenital heart defects

R analysis
id Study   Lib. in paper Exposition period    Study type 
 Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S18166
R76399		 Chan (Controls exposed to TCA), 2024 Cardiac malformations 1st trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.61 [0.08;4.87] C
excluded (control group) 		1/47   11/322 12 47
ref
S18145
R76284		 Chan (Controls unexposed, pop general), 2024 Cardiac malformations 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.98 [0.14;7.12] 1/47   8,107/462,377 8,108 47
ref
S13122
R50026		 Marks (Controls exposed to Bupropion), 2021 Cardiac Malformations during pregnancy (anytime or not specified) excluded retrospective cohort exposed to other treatment, sick Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.42 [0.72;2.79] C
excluded (exposition period) 		26/581   13/406 39 581
ref
S7472
R22323		 Anderson, 2020 Any heart defect 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.26 [0.80;1.97] -/-   0/- - -
ref
S6009
R15436		 Furu, 2015 Any cardiac defects 1st trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.83 [0.60;1.16] 46/3,950   26,745/2,266,875 26,791 3,950
ref
S7353
R21555		 Wemakor, 2015 Congenital heart defects 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.10 [0.41;2.95] 7/16   12,869/29,943 12,876 16
ref
S5890
R14783		 Ban (Controls unexposed, disease free), 2014 Heart congenital malformations 1st trimester retrospective cohort (claims database) unexposed, disease free excluded Adjustment: Yes Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.15 [0.36;3.65]
excluded (control group) 		-/933   2,444/325,294 - 933
ref
S5891
R14798		 Ban (Controls unexposed, sick), 2014 Heart congenital malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 1.09 [0.34;3.50] -/933   112/13,432 - 933
ref
S15006
R61470		 Nordeng - Citalopram/Escitalopram (Controls unexposed, NOS), 2012 Cardiovascular malformations 1st trimester cohort unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: no or not specified 1.51 [0.48;4.77]
excluded (control group) 		3/243   541/61,648 544 243
ref
S15007
R61484		 Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 Cardiovascular malformations 1st trimester cohort unexposed, sick Adjustment: No Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 1.86 [0.48;7.24] C 3/243   7/1,048 10 243
ref
S7005
R19864		 Merlob, 2009 Nonsyndromic congenital heart malformations 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 2.46 [0.15;41.53] C 0/13   1,083/67,636 1,083 13
ref
Total 7 studies 1.00 [0.78;1.28] 48,868 5,202
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Chan (Controls unexposed, pop general), 2024Chan, 2024 1 0.98[0.14; 7.12]8,108472%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Anderson, 2020Anderson, 2020 1.26[0.80; 1.97]--29%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Furu, 2015Furu, 2015 0.83[0.60; 1.16]26,7913,95055%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Wemakor, 2015Wemakor, 2015 1.10[0.41; 2.95]12,876166%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Ban (Controls unexposed, sick), 2014Ban, 2014 2 1.09[0.34; 3.50]-9334%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012Nordeng - Citalopram/Escitalo..., 2012 3 1.86[0.48; 7.24]102433%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Merlob, 2009Merlob, 2009 2.46[0.15; 41.53]1,083131%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (7 studies) I2 = 0% 1.00[0.78; 1.28]48,8685,2020.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, pop general; 2: Controls unexposed, sick; 3: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.89[0.66; 1.21]35,9925,1860%NAChan (Controls unexposed, pop general), 2024 Furu, 2015 Ban (Controls unexposed, sick), 2014 Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 Merlob, 2009 5 case control studiescase control studies 1.23[0.82; 1.85]12,876160%NAAnderson, 2020 Wemakor, 2015 2 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 0.98[0.76; 1.26]48,8584,0260%NAChan (Controls unexposed, pop general), 2024 Anderson, 2020 Furu, 2015 Wemakor, 2015 Merlob, 2009 5 unexposed, sickunexposed, sick 1.37[0.56; 3.31]101,1760%NABan (Controls unexposed, sick), 2014 Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 2 Tags Adjustment   - No  - No 1.96[0.58; 6.67]1,0932560%NANordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 Merlob, 2009 2   - Yes  - Yes 0.97[0.76; 1.25]47,7754,9460%NAChan (Controls unexposed, pop general), 2024 Anderson, 2020 Furu, 2015 Wemakor, 2015 Ban (Controls unexposed, sick), 2014 5 Monotherapy   - no or not specified  - no or not specified 1.96[0.58; 6.67]1,0932560%NANordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 Merlob, 2009 2   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 0.97[0.75; 1.25]47,7754,0130%NAChan (Controls unexposed, pop general), 2024 Anderson, 2020 Furu, 2015 Wemakor, 2015 4   - substance alone among the specific ...  - substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.09[0.34; 3.50]-933 -NABan (Controls unexposed, sick), 2014 1 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 1.37[0.56; 3.31]101,1760%NABan (Controls unexposed, sick), 2014 Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 2 All studiesAll studies 1.00[0.78; 1.28]48,8685,2020%NAChan (Controls unexposed, pop general), 2024 Anderson, 2020 Furu, 2015 Wemakor, 2015 Ban (Controls unexposed, sick), 2014 Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 Merlob, 2009 70.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.43.41.7310.000Chan (Controls unexposed, pop general), 2024Anderson, 2020Furu, 2015Wemakor, 2015Ban (Controls unexposed, sick), 2014Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012Merlob, 2009

Asymetry test p-value = 0.1730 (by Egger's regression)

slope=-0.1801 (0.1423); intercept=0.6868 (0.4324); t=1.5886; p=0.1730

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 15006, 5890, 18166

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.00[0.79; 1.28]51,8375,2020%NAChan (Controls unexposed, pop general), 2024 Anderson, 2020 Furu, 2015 Wemakor, 2015 Ban (Controls unexposed, disease free), 2014 Nordeng - Citalopram/Escitalopram (Controls unexposed, NOS), 2012 Merlob, 2009 7 unexposed, sick controlsunexposed, sick controls 1.37[0.56; 3.31]1131,1760%NABan (Controls unexposed, sick), 2014 Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 2 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.61[0.08; 4.87]1247 -NAChan (Controls exposed to TCA), 2024 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 De Vries (Congenital Heart Defects)De Vries (Congenital Heart Defects) 1.01[0.76; 1.33]0%-Wwhatever (meta-analysis)T11st trimesterstudies TTT3 metaPregmetaPreg 1.00[0.78; 1.28]0%5,202----Chan (Controls unexposed, pop general), 2024 Anderson, 2020 Furu, 2015 Wemakor, 2015 Ban (Controls unexposed, sick), 2014 Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012 Merlob, 2009 70.510.01.0