Venlafaxine 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.
S18320
R77165		 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, ...) 1.26 [0.27;5.85] C
excluded (control group) 		2/47   11/322 13 47
ref
S18321
R77168		 Chan (Controls unexposed, general pop), 2024 Cardiac malformations 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 2.46 [0.60;10.17] 2/47   8,107/462,377 8,109 47
ref
S13135
R50109		 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, ...) 0.70 [0.20;2.51] C
excluded (exposition period) 		3/132   13/406 16 132
ref
S11773
R43278		 Anderson, 2020 Any heart defect 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 2.15 [1.28;3.60] -/-   0/- - -
ref
S11698
R43047		 Bérard b (Controls unexposed, sick), 2017 Cardiac malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 0.80 [0.47;1.38] -/738   -/14,847 - 738
ref
S11689
R42980		 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, ...) 1.14 [0.82;1.57] 40/2,763   26,745/2,266,875 26,785 2,763
ref
S11797
R43401		 Oberlander, 2008 Cardiovascular congenital defects 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 0.84 [0.12;5.98] C 1/250   512/107,320 513 250
ref
Total 5 studies 1.29 [0.85;1.96] 35,407 3,798
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, general pop), 2024Chan, 2024 1 2.46[0.60; 10.17]8,109477%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Anderson, 2020Anderson, 2020 2.15[1.28; 3.60]--27%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Bérard b (Controls unexposed, sick), 2017Bérard b, 2017 2 0.80[0.47; 1.38]-73826%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Furu, 2015Furu, 2015 1.14[0.82; 1.57]26,7852,76336%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Oberlander, 2008Oberlander, 2008 0.84[0.12; 5.98]5132504%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Total (5 studies) I2 = 51% 1.29[0.85; 1.96]35,4073,7980.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

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

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.07[0.81; 1.40]35,4073,7980%NAChan (Controls unexposed, general pop), 2024 Bérard b (Controls unexposed, sick), 2017 Furu, 2015 Oberlander, 2008 4 case control studiescase control studies 2.15[1.28; 3.61]-- -NAAnderson, 2020 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.51[0.96; 2.39]35,4073,06041%NAChan (Controls unexposed, general pop), 2024 Anderson, 2020 Furu, 2015 Oberlander, 2008 4 unexposed, sickunexposed, sick 0.80[0.47; 1.37]-738 -NABérard b (Controls unexposed, sick), 2017 1 Tags Adjustment   - No  - No 0.84[0.12; 5.98]513250 -NAOberlander, 2008 1   - Yes  - Yes 1.32[0.83; 2.09]34,8943,54863%NAChan (Controls unexposed, general pop), 2024 Anderson, 2020 Bérard b (Controls unexposed, sick), 2017 Furu, 2015 4 Monotherapy   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.32[0.83; 2.09]34,8943,54863%NAChan (Controls unexposed, general pop), 2024 Anderson, 2020 Bérard b (Controls unexposed, sick), 2017 Furu, 2015 4   - substance alone among the specific ...  - substance alone among the specific class of antidep (SSRI, SNRI, ...) 0.84[0.12; 5.98]513250 -NAOberlander, 2008 1 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 0.80[0.47; 1.37]-738 -NABérard b (Controls unexposed, sick), 2017 1 All studiesAll studies 1.29[0.85; 1.96]35,4073,79851%NAChan (Controls unexposed, general pop), 2024 Anderson, 2020 Bérard b (Controls unexposed, sick), 2017 Furu, 2015 Oberlander, 2008 50.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.42.61.2040.000Chan (Controls unexposed, general pop), 2024Anderson, 2020Bérard b (Controls unexposed, sick), 2017Furu, 2015Oberlander, 2008

Asymetry test p-value = 0.7824 (by Egger's regression)

slope=0.1104 (0.3985); intercept=0.4403 (1.4581); t=0.3019; p=0.7824

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 18320

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.51[0.96; 2.39]35,4073,06041%NAChan (Controls unexposed, general pop), 2024 Anderson, 2020 Furu, 2015 Oberlander, 2008 4 unexposed, sick controlsunexposed, sick controls 0.80[0.47; 1.37]-738 -NABérard b (Controls unexposed, sick), 2017 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.26[0.27; 5.85]1347 -NAChan (Controls exposed to TCA), 2024 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Lou (Cardiac malformations)Lou (Cardiac malformations) 1.23[0.91; 1.67]42%-U,GPunexposed (general population or NOS)T11st trimesterstudies TTT2 Lou (Cardiac malformations)Lou (Cardiac malformations) 0.95[0.56; 1.62]56%-U,Sunexposed, sickT11st trimesterstudies TTT2 De Vries (Congenital Heart Defects)De Vries (Congenital Heart Defects) 1.30[0.99; 1.71]0%-Wwhatever (meta-analysis)T11st trimesterstudies TTT4 metaPregmetaPreg 1.29[0.85; 1.96]51%3,798----Chan (Controls unexposed, general pop), 2024 Anderson, 2020 Bérard b (Controls unexposed, sick), 2017 Furu, 2015 Oberlander, 2008 50.510.01.0