Citalopram updated on 07-01-2025

Limb 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.
S7471
R22316		 Anderson, 2020 Any limb deficiency 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.03 [0.37;2.91] -/-   0/- - -
ref
S7437
R21934		 Bérard, 2017 Musculoskeletal system 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) 1.92 [1.40;2.62] -/584   -/14,847 - 584
ref
S5884
R14727		 Ban (Controls unexposed, disease free), 2014 Limb malformations 1st trimester retrospective cohort (claims database) unexposed, disease free excluded Adjustment: Yes Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 0.68 [0.30;1.53]
excluded (control group) 		-/1,946   1,750/325,294 - 1,946
ref
S5885
R14742		 Ban (Controls unexposed, sick), 2014 Limb 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) 0.59 [0.26;1.37] -/1,946   71/13,432 - 1,946
ref
S10215
R37422		 De Jonge, 2013 Limb malformations 1st trimester case control unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 2.24 [0.14;36.66] C 0/35   184/29,372 184 35
ref
S6014
R15490		 Jimenez-Solem (Controls unexposed, NOS), 2012 Congenital malformations of the limbs 1st trimester population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.13 [0.76;1.70]
excluded (control group) 		24/1,606   11,785/843,797 11,809 1,606
ref
S6019
R15600		 Jimenez-Solem (Controls unexposed, sick), 2012 Congenital malformations of the limbs 1st trimester population based cohort retrospective unexposed, sick Adjustment: No Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 0.86 [0.44;1.67] C 24/1,606   14/806 38 1,606
ref
S7179
R20213		 Colvin, 2011 Musculoskeletal defects (ICD 754–756) 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.04 [0.54;2.02] 9/775   1,052/94,561 1,061 775
ref
S6241
R16487		 Malm, 2011 Musculoskeletal malformations (including limb defects) 1st trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.04 [0.72;1.50] -/2,799   -/628,607 - 2,799
ref
Total 7 studies 1.12 [0.78;1.59] 1,283 7,745
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 Anderson, 2020Anderson, 2020 1.03[0.37; 2.91]--9%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Bérard, 2017Bérard, 2017 1.92[1.40; 2.62]-58425%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Ban (Controls unexposed, sick), 2014Ban, 2014 1 0.59[0.26; 1.37]-1,94611%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate De Jonge, 2013De Jonge, 2013 2.24[0.14; 36.66]184352%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: critical Jimenez-Solem (Controls unexposed, sick), 2012Jimenez-Solem, 2012 2 0.86[0.44; 1.67]381,60615%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: critical Colvin, 2011Colvin, 2011 1.04[0.54; 2.02]1,06177515%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Malm, 2011Malm, 2011 1.04[0.72; 1.50]-2,79923%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Total (7 studies) I2 = 54% 1.12[0.78; 1.59]1,2837,7450.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

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

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.10[0.73; 1.65]1,0997,71069%NABérard, 2017 Ban (Controls unexposed, sick), 2014 Jimenez-Solem (Controls unexposed, sick), 2012 Colvin, 2011 Malm, 2011 5 case control studiescase control studies 1.13[0.43; 2.97]184350%NAAnderson, 2020 De Jonge, 2013 2 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.05[0.77; 1.42]1,2453,6090%NAAnderson, 2020 De Jonge, 2013 Colvin, 2011 Malm, 2011 4 unexposed, sickunexposed, sick 1.06[0.50; 2.27]384,13680%NABérard, 2017 Ban (Controls unexposed, sick), 2014 Jimenez-Solem (Controls unexposed, sick), 2012 3 Tags Adjustment   - No  - No 0.97[0.61; 1.54]1,2832,4160%NADe Jonge, 2013 Jimenez-Solem (Controls unexposed, sick), 2012 Colvin, 2011 3   - Yes  - Yes 1.15[0.69; 1.90]-5,32972%NAAnderson, 2020 Bérard, 2017 Ban (Controls unexposed, sick), 2014 Malm, 2011 4 Monotherapy   - no or not specified  - no or not specified 1.05[0.73; 1.52]1842,8340%NADe Jonge, 2013 Malm, 2011 2   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.72[1.08; 2.74]-58422%NAAnderson, 2020 Bérard, 2017 2   - substance alone among the specific ...  - substance alone among the specific class of antidep (SSRI, SNRI, ...) 0.84[0.56; 1.27]1,0994,3270%NABan (Controls unexposed, sick), 2014 Jimenez-Solem (Controls unexposed, sick), 2012 Colvin, 2011 3 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 1.06[0.50; 2.27]384,13680%NABérard, 2017 Ban (Controls unexposed, sick), 2014 Jimenez-Solem (Controls unexposed, sick), 2012 3 All studiesAll studies 1.12[0.78; 1.59]1,2837,74554%NAAnderson, 2020 Bérard, 2017 Ban (Controls unexposed, sick), 2014 De Jonge, 2013 Jimenez-Solem (Controls unexposed, sick), 2012 Colvin, 2011 Malm, 2011 70.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.43.51.7110.000Anderson, 2020Bérard, 2017Ban (Controls unexposed, sick), 2014De Jonge, 2013Jimenez-Solem (Controls unexposed, sick), 2012Colvin, 2011Malm, 2011

Asymetry test p-value = 0.2944 (by Egger's regression)

slope=0.5525 (0.3011); intercept=-1.2978 (1.1083); t=1.1710; p=0.2944

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 6014, 5884

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.04[0.82; 1.31]14,7957,1610%NAAnderson, 2020 Ban (Controls unexposed, disease free), 2014 De Jonge, 2013 Jimenez-Solem (Controls unexposed, NOS), 2012 Colvin, 2011 Malm, 2011 6 unexposed, sick controlsunexposed, sick controls 1.06[0.50; 2.27]1004,13680%NABérard, 2017 Ban (Controls unexposed, sick), 2014 Jimenez-Solem (Controls unexposed, sick), 2012 30.510.01.0