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Sertraline
Overall results
Study description
Excluded studies
Table
Graphic
auto
during pregnancy (anytime or not specified)
1st trimester
2nd trimester
3rd trimester
2nd and/or 3rd trimester
throughout pregnancy
early pregnancy
days before delivery
late pregnancy
preconception-only
periconceptional
preconceptional for kinetic reason
at least 1st trimester
3 months (or more) before pregnancy or during pregnancy
1st and 2nd trimester
3 months or more before pregnancy or1st trimester
Paternal exp. genotoxic window only (0–3 months preconception)
Paternal exposure: epigenetic window only (3–xxx months preconception)
Paternal exposure: genotoxic/epigenetic window (0–xxx months preconception)
Paternal exposure: other window
Whatever the period exposition
individual studies
Outcome
TE
95% CI
n cases
n exposed
k
Pub. bias
Congenital malformations
Congenital heart defects
Louik, 2007 Oberlander, 2008 Merlob, 2009 Reis (Controls unexposed, NOS), 2010 Colvin, 2011 Nordeng (Controls unexposed, sick), 2012 Ban (Controls unexposed, sick), 2014 Huybrechts (Controls unexposed, sick), 2014 Bérard (Controls unexposed, sick), 2015 Wemakor, 2015 Furu, 2015 Anderson, 2020 Chan (Controls unexposed, pop general), 2024
13
1.15
[
1.01
; 1.31]
55,992
24,718
critical
All congenital malformations (majors, minors, majors and minors, or unspecified)
Oberlander, 2008 Einarson, 2009 Reis (Controls unexposed, NOS), 2010 Colvin, 2011 Nordeng (Controls unexposed, sick), 2012 Ban (Controls unexposed, sick), 2014 Bérard (Controls unexposed, sick), 2015 Furu, 2015 Ozturk (Sertraline), 2016 Anderson, 2020 Chan (Controls unexposed, pop general), 2024
11
1.07
[
0.98
; 1.16]
135,158
14,154
low
Major congenital malformations
Oberlander, 2008 Einarson, 2009 Reis (Controls unexposed, NOS), 2010 Colvin, 2011 Nordeng (Controls unexposed, sick), 2012 Ban (Controls unexposed, sick), 2014 Bérard (Controls unexposed, sick), 2015 Furu, 2015 Ozturk (Sertraline), 2016 Anderson, 2020 Chan (Controls unexposed, pop general), 2024
11
1.07
[
0.98
; 1.17]
134,384
14,154
low
Limb defects
Colvin, 2011 Malm, 2011 Jimenez-Solem (Controls unexposed, sick), 2012 Ban (Controls unexposed, sick), 2014 Bérard (Controls unexposed, sick), 2015 Anderson, 2020
6
0.92
[
0.70
; 1.21]
1,781
3,717
not evaluable
Digestive system anomalies
Colvin, 2011 Malm, 2011 Jimenez-Solem (Controls unexposed, sick), 2012 Ban (Controls unexposed, disease free), 2014 Bérard (Controls unexposed, sick), 2015 Wemakor, 2015
6
1.16
[
0.71
; 1.88]
3,766
3,732
not evaluable
Cleft palate
Louik, 2007 Malm, 2011 Bérard (Controls unexposed, sick), 2015 Anderson, 2020
4
0.83
[
0.51
; 1.35]
403
1,281
not evaluable
Craniosynostosis
Louik, 2007 Malm, 2011 Bérard (Controls unexposed, sick), 2015 Wemakor, 2015 Furu, 2015 Anderson, 2020
6
1.88
[
1.41
; 2.51]
1,705
8,542
not evaluable
Respiratory system anomalies
Colvin, 2011 Malm, 2011 Jimenez-Solem (Controls unexposed, NOS), 2012 Ban (Controls unexposed, disease free), 2014 Bérard (Controls unexposed, sick), 2015 Wemakor, 2015
6
2.30
[
1.22
; 4.35]
1,335
3,733
serious
Ventricular septal defect
Malm, 2011 Jimenez-Solem (Controls unexposed, sick), 2012 Huybrechts (Controls unexposed, sick), 2014 Wemakor, 2015 Anderson, 2020
5
0.87
[
0.68
; 1.12]
12,456
12,771
not evaluable
Cardiac septal defects
Louik, 2007 Wemakor, 2015 Furu, 2015 Bérard (Controls unexposed, sick), 2015 Anderson, 2020
5
1.18
[
0.99
; 1.41]
27,146
7,693
not evaluable
Genital anomalies
Jimenez-Solem (Controls unexposed, sick), 2012 Ban (Controls unexposed, sick), 2014 Bérard (Controls unexposed, sick), 2015
3
0.68
[
0.29
; 1.61]
225
1,940
not evaluable
Hypospadias
Louik, 2007 Reis (Controls unexposed, NOS), 2010 Furu, 2015 Wemakor, 2015 Anderson, 2020
5
1.07
[
0.80
; 1.42]
8,079
10,607
not evaluable
Nervous system anomalies
Colvin, 2011 Malm, 2011 Jimenez-Solem (Controls unexposed, NOS), 2012 Ban (Controls unexposed, disease free), 2014 Bérard (Controls unexposed, sick), 2015
5
1.39
[
0.83
; 2.32]
858
3,717
not evaluable
Urinary malformations
Louik, 2007 Jimenez-Solem (Controls unexposed, NOS), 2012 Ban (Controls unexposed, disease free), 2014 Bérard (Controls unexposed, sick), 2015
4
1.07
[
0.57
; 2.01]
3,929
1,992
not evaluable
Atrial septal defect
Malm, 2011 Jimenez-Solem (Controls unexposed, sick), 2012 Wemakor, 2015 Anderson, 2020
4
1.31
[
0.93
; 1.83]
3,986
1,705
not evaluable
Cleft lip with or without cleft palate
Louik, 2007 Malm, 2011 Anderson, 2020
3
0.80
[
0.55
; 1.18]
704
918
not evaluable
Omphalocele
Louik, 2007 Bérard (Controls unexposed, sick), 2015 Anderson, 2020
3
2.07
[
0.59
; 7.21]
142
415
not evaluable
Oro-facial clefts
Jimenez-Solem (Controls unexposed, NOS), 2012 Ban (Controls unexposed, disease free), 2014 Anderson, 2020
3
0.79
[
0.56
; 1.11]
429
1,574
not evaluable
Ano-rectal atresia and stenosis
Louik, 2007 Furu, 2015 Wemakor, 2015 Anderson, 2020
4
1.89
[
0.98
; 3.65]
1,394
7,308
not evaluable
Club foot / Talipes equinovarus
Louik, 2007 Yazdy, 2014 Furu, 2015 Wemakor, 2015
4
1.90
[
1.35
; 2.67]
6,222
7,354
not evaluable
Ear, face and neck anomalies
Colvin, 2011 Jimenez-Solem (Controls unexposed, NOS), 2012 Ban (Controls unexposed, disease free), 2014 Wemakor, 2015
4
1.58
[
0.44
; 5.66]
1,044
2,496
not evaluable
Eye defects
Colvin, 2011 Jimenez-Solem (Controls unexposed, NOS), 2012 Ban (Controls unexposed, disease free), 2014 Wemakor, 2015
4
0.84
[
0.24
; 2.90]
1,215
2,496
not evaluable
Neural Tube Defects
Louik, 2007 Malm, 2011 Wemakor, 2015 Anderson, 2020
4
0.85
[
0.54
; 1.36]
1,642
931
not evaluable
Atrioventricular septal defect
Furu, 2015 Wemakor, 2015 Anderson, 2020
3
1.62
[
0.91
; 2.88]
1,369
7,260
not evaluable
Chromosomal abnormalities
Colvin, 2011 Jimenez-Solem (Controls unexposed, NOS), 2012 Ban (Controls unexposed, disease free), 2014
3
1.77
[
0.77
; 4.04]
749
2,482
not evaluable
Diaphragmatic hernia
Louik, 2007 Anderson, 2020
2
1.20
[
0.66
; 2.19]
192
47
not evaluable
Transposition of the great vessels
Malm, 2011 Wemakor, 2015 Anderson, 2020
3
1.26
[
0.70
; 2.28]
854
884
not evaluable
Abdominal wall defects
Ban (Controls unexposed, disease free), 2014
1
4.90
[
0.67
; 35.92]
69
757
not evaluable
Coarctation of aorta
Wemakor, 2015 Anderson, 2020
2
1.29
[
0.15
; 11.40]
570
16
not evaluable
Eye, ear, face and neck malformations
Bérard (Controls unexposed, sick), 2015
1
0.46
[
0.06
; 3.42]
87
366
not evaluable
Gastroschisis
Given, 2017 Anderson, 2020
2
1.94
[
0.49
; 7.62]
-
68
not evaluable
Hydrocephaly
Anderson, 2020
1
1.10
[
0.48
; 2.52]
-
-
not evaluable
Hypoplastic left heart (HLH/HLHS)
Wemakor, 2015 Anderson, 2020
2
1.69
[
0.93
; 3.04]
398
14
not evaluable
Limb reduction defects (LRD)
Louik, 2007 Wemakor, 2015
2
3.01
[
0.95
; 9.47]
977
63
not evaluable
Microcephaly / Small head circumference for gestational age
Kivistö, 2016 Kerr, 2018
2
1.14
[
0.38
; 3.39]
1,757
142
not evaluable
Pulmonary valve stenosis
Wemakor, 2015 Anderson, 2020
2
1.81
[
1.22
; 2.68]
772
15
not evaluable
Spina bifida
Anderson, 2020
1
0.69
[
0.35
; 1.36]
-
-
not evaluable
Tetralogy of Fallot
Wemakor, 2015 Anderson, 2020
2
1.80
[
1.14
; 2.84]
428
15
not evaluable
Anotia
Anderson, 2020
1
0.75
[
0.27
; 2.06]
-
-
not evaluable
Aortic valve atresia/stenosis
0
-
-
-
-
-
Congenital cataract
Anderson, 2020
1
1.14
[
0.46
; 2.83]
-
-
not evaluable
Congenital glaucoma
Anderson, 2020
1
2.79
[
1.12
; 6.97]
-
-
not evaluable
Congenital hydronephrosis
0
-
-
-
-
-
Duodenal atresia or stenosis
Anderson, 2020
1
1.63
[
0.59
; 4.48]
-
-
not evaluable
Ebstein's anomaly
Wemakor, 2015
1
16.42
[
2.10
; 128.38]
93
15
not evaluable
Encephalocele
0
-
-
-
-
-
Hip dislocation and/or dysplasia
0
-
-
-
-
-
Hirschsprung's disease
0
-
-
-
-
-
Multicystic renal dysplasia
Wemakor, 2015
1
1.02
[
0.06
; 17.21]
618
14
not evaluable
Oesophageal atresia with or without tracheo-oesophageal fistula
Anderson, 2020
1
1.04
[
0.52
; 2.06]
-
-
not evaluable
Patent ductus arterious
0
-
-
-
-
-
Polydactyly
0
-
-
-
-
-
Pulmonary valve atresia
0
-
-
-
-
-
Severe congenital heart defect
Wemakor, 2015
1
2.88
[
1.09
; 7.61]
2,935
20
not evaluable
Syndactyly
0
-
-
-
-
-
Growth parameters and prematurity
Preterm (< 37 weeks)
Calderon-Margalit, 2009 Colvin, 2011 Kivistö, 2016 Ozturk (Sertraline), 2016 Heinonen, 2021 Marks (Controls exposed to Bupropion), 2021 Martin, 2024 Lee (Controls unexposed, general pop), 2025
8
1.28
[
1.12
; 1.45]
161,058
38,373
not evaluable
Low birth weight (< 2500g)
Colvin, 2011 Kivistö, 2016 Lee (Controls unexposed, general pop), 2025
3
1.28
[
1.10
; 1.50]
39,840
2,053
not evaluable
Small for gestational age (weight)
Kivistö, 2016 Martin, 2024 Lee (Controls unexposed, general pop), 2025
3
0.99
[
0.75
; 1.32]
241,514
31,047
not evaluable
Large for gestational age (weight)
Kivistö, 2016 Lee (Controls unexposed, general pop), 2025
2
0.64
[
0.29
; 1.39]
11,932
692
not evaluable
Large for gestational age (length)
Kivistö, 2016
1
0.31
[
0.13
; 0.72]
1,472
-
not evaluable
Large head circumference for gestational age
Kivistö, 2016
1
0.93
[
0.33
; 2.64]
2,560
-
not evaluable
Small for gestational age (length)
Kivistö, 2016
1
1.68
[
0.68
; 4.15]
1,838
-
not evaluable
Maternal consequences
Caesarean
Colvin, 2011 Kivistö, 2016 Lee (Controls unexposed, general pop), 2025
3
1.10
[
1.00
; 1.21]
146,313
2,032
not evaluable
Postpartum hemorrhage
Colvin, 2011 Palmsten b, 2013 Lee (Controls unexposed, general pop), 2025
3
1.25
[
1.12
; 1.40]
30,457
6,509
not evaluable
Assisted deliveries (forceps, vacuum, ...)
Kivistö, 2016 Lee (Controls unexposed, general pop), 2025
2
1.28
[
0.98
; 1.68]
47,693
692
not evaluable
Preeclampsia
De Vera, 2012 Palmsten (Controls unexposed, sick), 2013
2
1.17
[
0.72
; 1.90]
4,829
7,143
not evaluable
Maternal consequences (as a whole)
Lee (Controls unexposed, general pop), 2025
1
1.45
[
1.20
; 1.75]
311,586
643
not evaluable
Gestational diabetes
Dandjinou, 2019
1
1.01
[
0.80
; 1.28]
20,905
823
not evaluable
Neonatal disorders
Low Apgar score (< 7) (at 5 min)
Colvin, 2011 Kivistö, 2016 Marks (Controls exposed to Bupropion), 2021 Heinonen, 2021 Martin, 2024 Lee (Controls unexposed, general pop), 2025
6
1.53
[
1.06
; 2.21]
35,902
35,433
not evaluable
Neonatal medical care
Oberlander, 2004 Kivistö, 2016 Marks (Controls exposed to Bupropion), 2021 Cornet, 2024 Lee (Controls unexposed, general pop), 2025
5
1.35
[
0.91
; 2.02]
23,551
7,510
not evaluable
Withdrawal syndrome / Neonatal abstinence syndrome / Poor neonatal adaptation
Levinson-Castiel, 2006 Dave, 2019 Marks (Controls unexposed, sick), 2021 Heinonen, 2021
4
3.43
[
0.81
; 14.60]
662
4,691
not evaluable
Low Apgar score (< 7) (at 1 min)
Kivistö, 2016 Lee (Controls unexposed, general pop), 2025
2
1.35
[
0.93
; 1.96]
16,353
692
not evaluable
Neonatal death (< 28 days of life)
Lee (Controls unexposed, general pop), 2025
1
0.57
[
0.04
; 9.20]
627
643
not evaluable
Persistent pulmonary hypertension
Chambers, 2006 Kieler, 2012 Marks (Controls exposed to Bupropion), 2021
3
2.75
[
1.45
; 5.23]
2,325
4,505
not evaluable
Neonatal disorders (as a whole)
Lee (Controls unexposed, general pop), 2025
1
2.01
[
1.71
; 2.36]
161,729
643
not evaluable
Fetal distress
Colvin, 2011
1
1.18
[
1.02
; 1.37]
12,883
1,340
not evaluable
Jaundice / Icterus
Marks (Controls exposed to Bupropion), 2021
1
0.87
[
0.64
; 1.18]
291
1,653
not evaluable
Low Apgar score (< 7) (at 10 min)
Heinonen, 2021
1
0.33
[
0.01
; 21.64]
-
8
not evaluable
Neonatal tachypnea
Marks (Controls exposed to Bupropion), 2021
1
1.23
[
0.84
; 1.80]
207
1,653
not evaluable
Long term consequences
Child/Infant death (> 28 days of life)
Colvin, 2012 Lee (Controls unexposed, general pop), 2025
2
1.47
[
0.97
; 2.24]
1,210
643
not evaluable
Intrauterine deaths
Early intrauterine deaths (< 22 weeks) / Spontaneous abortions
Yaris, 2005 Nakhai-Pour, 2010 Andersen, 2014 Ozturk (Sertraline), 2016 Kitchin, 2022
5
1.43
[
1.32
; 1.55]
162,420
4,608
not evaluable
Intrauterine deaths (as a whole or unspecified)
Colvin, 2011 Sjaarda, 2020
2
1.10
[
0.91
; 1.33]
24,717
1,189
not evaluable
Late intrauterine deaths (> 22 weeks) / Stillbirths
Colvin, 2011
1
1.48
[
0.85
; 2.58]
625
1,361
not evaluable
Ectopic pregnancy
Colvin, 2011
1
1.13
[
0.62
; 2.05]
1,499
1,167
not evaluable
Elective/induced termination of pregnancy
Ozturk (Sertraline), 2016
1
2.19
[
0.46
; 10.45]
16
19
not evaluable
Neuro-developmental disorders
ASD (Autism spectrum disorder): Diagnosis
Bérard, 2016 Brown, 2017 Viktorin (Controls unexposed, sick), 2017 Rai (Controls unexposed, sick), 2017 Suarez (Controls unexposed, discontinuers), 2022 Heuvelman, 2023
6
1.25
[
1.03
; 1.51]
1,786
59,686
not evaluable
ASD (Autism spectrum disorder): Diagnosis/Risk
Bérard, 2016 Brown, 2017 Viktorin (Controls unexposed, sick), 2017 Rai (Controls unexposed, sick), 2017 Suarez (Controls unexposed, discontinuers), 2022 Heuvelman, 2023
6
1.25
[
1.03
; 1.51]
1,786
59,686
not evaluable
ADHD (Attention deficit hyperactivity disorder): Diagnosis
Suarez (Controls unexposed, discontinuers), 2022 Heuvelman, 2023
2
1.05
[
0.91
; 1.21]
1,867
57,810
not evaluable
ADHD (Attention deficit hyperactivity disorder): Diagnosis/Risk
Suarez (Controls unexposed, discontinuers), 2022 Heuvelman, 2023
2
1.05
[
0.91
; 1.21]
1,867
57,810
not evaluable
Cognitive developmental disorders/delay (3-6 years old)
Suarez (Controls unexposed, discontinuers), 2022
1
1.35
[
0.70
; 2.59]
76
32,988
not evaluable
Language disorders/delay
Suarez (Controls unexposed, discontinuers), 2022
1
1.16
[
0.98
; 1.37]
2,174
55,722
not evaluable
Learning disorders
Suarez (Controls unexposed, discontinuers), 2022
1
0.79
[
0.50
; 1.25]
149
55,722
not evaluable
Neuro-developmental disorders (as a whole)
Suarez (Controls unexposed, discontinuers), 2022
1
1.10
[
0.98
; 1.23]
4,390
55,722
not evaluable
Psychomotor developmental disorders/delay
Suarez (Controls unexposed, discontinuers), 2022
1
1.11
[
0.74
; 1.67]
282
55,722
not evaluable
Severe cognitive developmental delay (Mental retardation) (3-6 years old)
Suarez (Controls unexposed, discontinuers), 2022
1
1.35
[
0.70
; 2.59]
76
32,988
not evaluable
Cognitive developmental disorders/delay (> 6 years old)
Heuvelman, 2023
1
0.61
[
0.23
; 1.60]
-
2,088
not evaluable
Severe cognitive developmental delay (Mental retardation) (> 6 years old)
Heuvelman, 2023
1
0.61
[
0.23
; 1.60]
-
2,088
not evaluable
0.0
100.0
1.0