MTHFR A1298C polymorphisms reduce the risk of congenital heart defects: a meta-analysis from 16 case-control studies

AbstractBackgroundAntidepressant use during the first trimester is reported in 4% to 8% of pregnancies. The use of some selective serotonin reuptake inhibitors (SSRI) during this stage of gestation has been identified as increasing the odds for congenital heart defects, however little is known about the safety of non-SSRI antidepressants.ObjectiveTo assess the odds of congenital heart defects associated with the use of any antidepressant during the first trimester of pregnancy. To investigate individual classes of antidepressants: SSRIs, serotonin norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA) and individual antidepressants.Data sourcesPubMed and Embase were searched without restrictions from inception till 2 January 2020.Study selectionProspective and retrospective cohort and case-control studies were included if they documented the maternal usage of antidepressants during the first trimester of pregnancy and assessed the presence of congenital heart defects.Data extraction and meta-analysisData were extracted by two independent reviewers and the endpoint assessed was congenital heart defects. Where studies reported multiple results for different types of heart defects or individual antidepressants, results were combined when possible. Analyses assessing individual antidepressants and classes of antidepressants (SSRIs, SNRIs and TCAs) were undertaken.ResultsA total of 16 studies were identified, encompassing 4,564,798 pregnancy outcomes. The odds ratio for maternal use of any antidepressant and the presence of congenital heart defects from the mixed-methods meta-analysis was 1.22 (95% confidence interval (CI): 1.11 to 1.33).Analyses of antidepressants by class produced an odds ratio of 1.50 (95% CI: 1.19 to 1.89) for maternal SNRI use during the first trimester of pregnancy and the formation of congenital heart defects. A significant odds ratio of 1.22 (95% CI: 1.12 to 1.33) was reported for SSRIs. For the TCA class, no increased odds ratio was found.Analyses of individual antidepressants produced significant odds ratios of 1.53 (95% CI: 1.25 to 1.88), 1.28 (95% CI: 1.01 to 1.62), 1.28 (95% CI: 1.14 to 1.45) and 1.23 (95% CI: 1.01 to 1.50) for paroxetine, fluoxetine, sertraline and bupropion respectively.ConclusionWhile some insight has been gained into which classes of antidepressant and individual antidepressants pose more risk than others for causing congenital heart defects, information regarding some antidepressants is still lacking.

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Early pregnancy exposure to antihistamines and risk of congenital heart defects: results of two case–control studies

European Journal of Epidemiology ◽

10.1007/s10654-014-9925-0 ◽

2014 ◽

Vol 29 (9) ◽

pp. 653-661 ◽

Cited By ~ 4

Author(s):

Huberdina P. M. Smedts ◽

Linda de Jonge ◽

Sarah J. G. Bandola ◽

Marlies E. Baardman ◽

Marian K. Bakker ◽

...

Keyword(s):

Congenital Heart Defects ◽

Early Pregnancy ◽

Congenital Heart ◽

Heart Defects ◽

Case Control ◽

Case Control Studies

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Faculty Opinions recommendation of Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717697909.793152973 ◽

2012 ◽

Author(s):

Willem Helbing

Keyword(s):

Systematic Review ◽

Pulse Oximetry ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Meta Analysis ◽

Pulse Oximetry Screening

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Children Born with Congenital Heart Defects and Growth Restriction at Birth: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093056 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3056 ◽

Cited By ~ 1

Author(s):

Ali Ghanchi ◽

Neil Derridj ◽

Damien Bonnet ◽

Nathalie Bertille ◽

Laurent J. Salomon ◽

...

Keyword(s):

Systematic Review ◽

Congenital Heart Defects ◽

Gestational Age ◽

Small For Gestational Age ◽

Congenital Heart ◽

Heart Defects ◽

Data Extraction ◽

Meta Analysis ◽

Adverse Outcomes ◽

Growth Restriction

Newborns with congenital heart defects tend to have a higher risk of growth restriction, which can be an independent risk factor for adverse outcomes. To date, a systematic review of the relation between congenital heart defects (CHD) and growth restriction at birth, most commonly estimated by its imperfect proxy small for gestational age (SGA), has not been conducted. Objective: To conduct a systematic review and meta-analysis to estimate the proportion of children born with CHD that are small for gestational age (SGA). Methods: The search was carried out from inception until 31 March 2019 on Pubmed and Embase databases. Studies were screened and selected by two independent reviewers who used a predetermined data extraction form to obtain data from studies. Bias was assessed using the Critical Appraisal Skills Programme (CASP) checklist. The database search identified 1783 potentially relevant publications, of which 38 studies were found to be relevant to the study question. A total of 18 studies contained sufficient data for a meta-analysis, which was done using a random effects model. Results: The pooled proportion of SGA in all CHD was 20% (95% CI 16%–24%) and 14% (95% CI 13%–16%) for isolated CHD. Proportion of SGA varied across different CHD ranging from 30% (95% CI 24%–37%) for Tetralogy of Fallot to 12% (95% CI 7%–18%) for isolated atrial septal defect. The majority of studies included in the meta-analysis were population-based studies published after 2010. Conclusion: The overall proportion of SGA in all CHD was 2-fold higher whereas for isolated CHD, 1.4-fold higher than the expected proportion in the general population. Although few studies have looked at SGA for different subtypes of CHD, the observed variability of SGA by subtypes suggests that growth restriction at birth in CHD may be due to different pathophysiological mechanisms.

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