Escitalopram updated on 07-01-2025

Major congenital malformations

id	Study   Auto Chan (Controls exposed to TCA), 2024Chan (Controls unexposed, pop general), 2024Anderson, 2020Jordan, 2016Ozturk, 2016Furu, 2015Ban (Controls unexposed, disease free), 2014Ban (Controls unexposed, sick), 2014Klieger-Grossmann, 2012Nordeng - Citalopram/Escitalopram (Controls unexposed, NOS), 2012Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012Einarson, 2009	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimesterPaternal 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	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S18166 R76398	Chan (Controls exposed to TCA), 2024	Any major malformations	1st trimester	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	0.53 [0.12;2.31] C excluded (control group)	2/47   25/322	27	47		ref
S18145 R76283	Chan (Controls unexposed, pop general), 2024	Any major malformations	1st trimester	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	0.74 [0.18;3.07]	2/47   22,628/462,377	22,630	47		ref
S7472 R41461	Anderson, 2020	Major birth defects	1st trimester	case control	unexposed (general population or NOS)	Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	1.09 [0.74;1.60] C	102/137   30,528/41,971	30,630	137		ref
S8218 R25661	Jordan, 2016	All major congenital anomalies	3 months or more before pregnancy or1st trimester excluded	retrospective cohort (registry)	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	1.01 [0.81;1.25] excluded (exposition period)	86/3,236   13,536/506,155	13,622	3,236		ref
S7520 R22540	Ozturk, 2016	Major congenital defects	at least 1st trimester	prospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	1.17 [0.06;23.30] C	0/30   3/246	3	30		ref
S6009 R15435	Furu, 2015	Major birth defects	1st trimester	population based cohort retrospective	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	0.89 [0.73;1.10]	107/3,950   71,374/2,266,875	71,481	3,950		ref
S5890 R14782	Ban (Controls unexposed, disease free), 2014	Major congenital anomalies	1st trimester	retrospective cohort (claims database)	unexposed, disease free excluded	Adjustment: Yes Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...)	0.85 [0.40;1.81] excluded (control group)	-/933   8,731/325,294	-	933		ref
S5891 R14797	Ban (Controls unexposed, sick), 2014	Major congenital anomalies	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)	0.77 [0.36;1.66]	-/933   380/13,432	-	933		ref
S6190 R16310	Klieger-Grossmann, 2012	Major malformation (among live births)	1st trimester	prospective cohort	unexposed (general population or NOS)	Adjustment: No Matched Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	1.68 [0.28;10.16] C	3/172   2/191	5	172		ref
S15006 R61469	Nordeng - Citalopram/Escitalopram (Controls unexposed, NOS), 2012	Major malformations	1st trimester	cohort	unexposed (general population or NOS) excluded	Adjustment: Yes Monotherapy: no or not specified	0.99 [0.44;2.25] excluded (control group)	6/243   1,550/61,648	1,556	243		ref
S15007 R61483	Nordeng - Citalopram/Escitalopram (Controls unexposed, sick), 2012	Major 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)	0.86 [0.35;2.09] C	6/243   30/1,048	36	243		ref
S5967 R15343	Einarson, 2009	Major malformations	1st trimester	prospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	0.86 [0.05;14.67] C	0/21   25/928	25	21		ref
					Total	8 studies	0.92 [0.78;1.09]		124,810	5,533
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

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded 15006, 5890, 18166