{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:17:49Z","timestamp":1790713069083,"version":"4.1.0"},"reference-count":64,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Clinical guidelines recommend screening and treating bacteriuria in early pregnancy given that urinary tract infections (UTIs) can cause serious maternal and neonatal consequences. Evidence regarding antibiotic exposure during early pregnancy and risk of congenital malformations is limited and inconsistent.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the risk of congenital malformations following first-trimester exposure to different antibiotic agents used to treat UTI.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This population-based cohort study included commercially insured pregnant individuals aged 15 to 49 years who were treated for UTI and linked liveborn infants in the Merative MarketScan Commercial Database (2006-2022).<\/jats:p><\/jats:sec>Exposure<\/jats:title>First-trimester antibiotic prescription fill of nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin), and \u03b2-lactams to treat UTI.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Congenital malformations (any and by organ system) were identified using validated algorithms based on diagnosis codes up to 365 days after birth. Log-binomial regression models were used to estimate propensity score\u2013weighted risk ratios (RRs) and risk differences.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort of 71\u202f604 eligible pregnancies (median maternal [IQR] age, 30 [27-34] years) included 42\u202f402 (59.2%) nitrofurantoin-exposed, 3494 (4.9%) TMP-SMX\u2013exposed, 3663 (5.1%) fluoroquinolone-exposed, and 22\u202f045 (30.8%) \u03b2-lactam\u2013exposed individuals. Median (IQR) gestational age differed by antibiotic (nitrofurantoin, 62 [45-77] days; TMP-SMX, 26 [13-59] days; fluoroquinolones, 18 [9-27] days; \u03b2-lactams, 63 [48-77] days). The absolute risk of any malformation was 19.8 (95% CI, 18.0-21.8) per 1000 infants for \u03b2-lactams, 21.2 (95% CI, 19.9-22.7) per 1000 infants for nitrofurantoin, 23.5 (95% CI, 18.8-28.9) per 1000 infants for fluoroquinolones, and 26.9 (95% CI, 21.8-32.8) per 1000 infants for TMP-SMX. After accounting for confounding, risk of any congenital malformation was higher for TMP-SMX (RR, 1.35; 95% CI, 1.04-1.75) but similar for nitrofurantoin (RR, 1.12; 95% CI, 1.00-1.26) and fluoroquinolones (RR, 1.18; 95% CI, 0.87-1.60) compared with \u03b2-lactams. TMP-SMX was associated with increased risk of severe cardiac malformations (RR, 2.09; 95% CI, 1.09-3.99), other cardiac malformations (RR, 1.52; 95% CI, 1.02-2.25), and cleft lip and palate (RR, 3.23; 95% CI, 1.44-7.22) compared with \u03b2-lactams; however, for these specific malformations, the corresponding risk difference estimates included the null. Risk of other malformation types did not differ by agent, although some estimates were imprecise. Results were generally consistent across sensitivity analyses.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of first-trimester antibiotic exposure, the risk of any malformation, severe cardiac malformation, other cardiac malformation, and cleft lip and palate was higher for infants exposed to TMP-SMX vs \u03b2-lactam antibiotics. No elevated risk was observed for nitrofurantoin.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.19544","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T15:00:45Z","timestamp":1752073245000},"page":"e2519544","source":"Crossref","is-referenced-by-count":13,"title":["First-Trimester Antibiotic Use for Urinary Tract Infection and Risk of Congenital Malformations"],"prefix":"10.1001","volume":"8","author":[{"given":"Sarah S.","family":"Osmundson","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelin B.","family":"Nickel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Shortreed","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Department of Biostatistics, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Dublin","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Department of Epidemiology, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin","family":"Stwalley","sequence":"additional","affiliation":[{"name":"Institute for Informatics, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Durkin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige D.","family":"Wartko","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Sahrmann","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Colvin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Butler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri"},{"name":"Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"issue":"3","key":"zoi250608r1","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1016\/S0891-5520(05)70375-5","article-title":"Detection, significance, and therapy of bacteriuria in pregnancy: update in the managed health care era.","volume":"11","author":"Patterson","year":"1997","journal-title":"Infect Dis Clin North Am"},{"key":"zoi250608r2","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.puhe.2023.08.016","article-title":"Global prevalence of urinary tract infection in pregnant mothers: a systematic review and meta-analysis.","volume":"224","author":"Salari","year":"2023","journal-title":"Public Health"},{"issue":"14","key":"zoi250608r3","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1055\/s-0041-1739289","article-title":"The Risk of preterm birth in low risk pregnant women with urinary tract infections.","volume":"40","author":"Werter","year":"2023","journal-title":"Am J Perinatol"},{"issue":"2","key":"zoi250608r4","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1097\/AOG.0000000000005269","article-title":"Urinary tract infections in pregnant individuals.","volume":"142","author":"Urinary Tract Infections in Pregnant Individuals","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"12","key":"zoi250608r5","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1001\/jama.2019.10060","article-title":"Screening for asymptomatic bacteriuria in adults: updated evidence report and systematic review for the US Preventive Services Task Force.","volume":"322","author":"Henderson","year":"2019","journal-title":"JAMA"},{"issue":"11","key":"zoi250608r6","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1016\/S1473-3099(15)00070-5","article-title":"Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial.","volume":"15","author":"Kazemier","year":"2015","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"zoi250608r9","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1001\/archpediatrics.2009.188","article-title":"Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study.","volume":"163","author":"Crider","year":"2009","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"2","key":"zoi250608r10","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/S1701-2163(15)30337-6","article-title":"Exposure to nitrofurantoin during early pregnancy and congenital malformations: a systematic review and meta-analysis.","volume":"37","author":"Goldberg","year":"2015","journal-title":"J Obstet Gynaecol Can"},{"issue":"3","key":"zoi250608r11","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1002\/pds.2179","article-title":"Maternal use of antibiotics and the risk of orofacial clefts: a nationwide cohort study.","volume":"21","author":"M\u00f8lgaard-Nielsen","year":"2012","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"2","key":"zoi250608r12","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1111\/j.1741-4520.2004.00012.x","article-title":"Possible association between different congenital abnormalities and use of different sulfonamides during pregnancy.","volume":"44","author":"Czeizel","year":"2004","journal-title":"Congenit Anom (Kyoto)"},{"issue":"6","key":"zoi250608r13","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1016\/S0890-6238(01)00178-2","article-title":"The teratogenic risk of trimethoprim-sulfonamides: a population based case-control study.","volume":"15","author":"Czeizel","year":"2001","journal-title":"Reprod Toxicol"},{"key":"zoi250608r14","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.123.001385","article-title":"Efflux transporters in drug disposition during pregnancy.","author":"Chen","journal-title":"Drug Metab Dispos"},{"issue":"2","key":"zoi250608r15","first-page":"265","article-title":"Transfer of nitrofurantoin across the human placenta.","volume":"25","author":"Perry","year":"1967","journal-title":"Tex Rep Biol Med"},{"issue":"1","key":"zoi250608r17","doi-asserted-by":"publisher","first-page":"18","DOI":"10.15585\/mmwr.mm6701a4","article-title":"Antibiotics dispensed to privately insured pregnant women with urinary tract infections\u2014United States, 2014.","volume":"67","author":"Ailes","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"6","key":"zoi250608r19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0067405","article-title":"Harnessing the Medicaid Analytic eXtract (MAX) to evaluate medications in pregnancy: design considerations.","volume":"8","author":"Palmsten","year":"2013","journal-title":"PLoS One"},{"issue":"4","key":"zoi250608r20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0284893","article-title":"Identification of pregnancies and their outcomes in healthcare claims data, 2008-2019: An algorithm.","volume":"18","author":"Ailes","year":"2023","journal-title":"PLoS One"},{"issue":"9","key":"zoi250608r21","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1002\/pds.4794","article-title":"Identifying pregnancies in insurance claims data: Methods and application to retinoid teratogenic surveillance.","volume":"28","author":"MacDonald","year":"2019","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"1","key":"zoi250608r23","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/EDE.0000000000001559","article-title":"Development and validation of algorithms to estimate live birth gestational age in Medicaid Analytic eXtract data.","volume":"34","author":"Zhu","year":"2023","journal-title":"Epidemiology"},{"issue":"9","key":"zoi250608r24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003322","article-title":"Gabapentin in pregnancy and the risk of adverse neonatal and maternal outcomes: a population-based cohort study nested in the US Medicaid Analytic eXtract dataset.","volume":"17","author":"Patorno","year":"2020","journal-title":"PLoS Med"},{"issue":"5","key":"zoi250608r25","doi-asserted-by":"publisher","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"3","key":"zoi250608r26","doi-asserted-by":"publisher","first-page":"e150","DOI":"10.1097\/AOG.0000000000002300","article-title":"717: sulfonamides, nitrofurantoin, and risk of birth defects.","volume":"130","author":"Committee Opinion No","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"2","key":"zoi250608r27","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1002\/pds.5177","article-title":"Developing algorithms for identifying major structural birth defects using automated electronic health data.","volume":"30","author":"Kharbanda","year":"2021","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"4","key":"zoi250608r28","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1002\/pds.4153","article-title":"Identifying birth defects in automated data sources in the Vaccine Safety Datalink.","volume":"26","author":"Kharbanda","year":"2017","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"1","key":"zoi250608r30","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data.","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"issue":"2","key":"zoi250608r31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0146822","article-title":"Identification of Medicare Recipients at Highest Risk for Clostridium difficile Infection in the US by Population Attributable Risk Analysis.","volume":"11","author":"Dubberke","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"zoi250608r33","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/biomet\/70.1.41","article-title":"The central role of the propensity score in observational studies for causal effects.","volume":"70","author":"Rosenbaum","year":"1983","journal-title":"Biometrika"},{"issue":"6","key":"zoi250608r34","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1097\/01.EDE.0000081989.82616.7d","article-title":"Marginal structural models as a tool for standardization.","volume":"14","author":"Sato","year":"2003","journal-title":"Epidemiology"},{"issue":"6","key":"zoi250608r35","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1111\/joim.12197","article-title":"Propensity scores for confounder adjustment when assessing the effects of medical interventions using nonexperimental study designs.","volume":"275","author":"St\u00fcrmer","year":"2014","journal-title":"J Intern Med"},{"issue":"1","key":"zoi250608r36","doi-asserted-by":"publisher","first-page":"121","DOI":"10.2307\/2531248","article-title":"Longitudinal data analysis for discrete and continuous outcomes.","volume":"42","author":"Zeger","year":"1986","journal-title":"Biometrics"},{"issue":"1","key":"zoi250608r37","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1093\/biomet\/73.1.13","article-title":"Longitudinal data analysis using generalized linear models.","volume":"73","author":"Liang","year":"1986","journal-title":"Biometrika"},{"issue":"24","key":"zoi250608r38","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1056\/NEJM197812142992410","article-title":"A show of confidence.","volume":"299","author":"Rothman","year":"1978","journal-title":"N Engl J Med"},{"issue":"4","key":"zoi250608r39","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s10654-016-0149-3","article-title":"Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations.","volume":"31","author":"Greenland","year":"2016","journal-title":"Eur J Epidemiol"},{"issue":"6","key":"zoi250608r41","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1001\/jama.2018.21554","article-title":"Using the E-value to assess the potential effect of unmeasured confounding in observational studies.","volume":"321","author":"Haneuse","year":"2019","journal-title":"JAMA"},{"issue":"5","key":"zoi250608r42","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1097\/EDE.0000000000000864","article-title":"Web site and R package for computing E-values.","volume":"29","author":"Mathur","year":"2018","journal-title":"Epidemiology"},{"issue":"23","key":"zoi250608r44","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1001\/jama.2018.18307","article-title":"Association of maternal first-trimester ondansetron use with cardiac malformations and oral clefts in offspring.","volume":"320","author":"Huybrechts","year":"2018","journal-title":"JAMA"},{"issue":"9","key":"zoi250608r46","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1002\/jcph.139","article-title":"Exposure to nitrofurantoin during the first trimester of pregnancy and the risk for major malformations.","volume":"53","author":"Goldberg","year":"2013","journal-title":"J Clin Pharmacol"},{"issue":"2","key":"zoi250608r47","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1002\/pds.3919","article-title":"Trimethoprim-sulfonamide use during the first trimester of pregnancy and the risk of congenital anomalies.","volume":"25","author":"Hansen","year":"2016","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"1","key":"zoi250608r48","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/S0301-2115(00)00364-X","article-title":"Nitrofurantoin and congenital abnormalities.","volume":"95","author":"Czeizel","year":"2001","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"3","key":"zoi250608r49","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1002\/pds.5407","article-title":"Core concepts in pharmacoepidemiology: confounding by indication and the role of active comparators.","volume":"31","author":"Sendor","year":"2022","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"4","key":"zoi250608r50","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s40471-015-0053-5","article-title":"The active comparator, new user study design in pharmacoepidemiology: historical foundations and contemporary application.","volume":"2","author":"Lund","year":"2015","journal-title":"Curr Epidemiol Rep"},{"issue":"3","key":"zoi250608r51","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1007\/s40471-018-0155-y","article-title":"The importance and implications of comparator selection in pharmacoepidemiologic research.","volume":"5","author":"D\u2019Arcy","year":"2018","journal-title":"Curr Epidemiol Rep"},{"issue":"3","key":"zoi250608r52","doi-asserted-by":"publisher","first-page":"134","DOI":"10.5694\/mja2.50261","article-title":"Infections in pregnancy.","volume":"211","author":"Keighley","year":"2019","journal-title":"Med J Aust"},{"issue":"6","key":"zoi250608r54","first-page":"389","article-title":"Intent to become pregnant as a predictor of exposures during pregnancy: is there a relation?","volume":"50","author":"Than","year":"2005","journal-title":"J Reprod Med"},{"issue":"5 Pt 2","key":"zoi250608r55","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1542\/peds.111.S1.1136","article-title":"Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children.","volume":"111","author":"Naimi","year":"2003","journal-title":"Pediatrics"},{"issue":"4","key":"zoi250608r56","doi-asserted-by":"publisher","first-page":"663","DOI":"10.2105\/AJPH.88.4.663","article-title":"Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies.","volume":"88","author":"Hellerstedt","year":"1998","journal-title":"Am J Public Health"},{"issue":"4","key":"zoi250608r57","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1002\/pds.1906","article-title":"Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women.","volume":"19","author":"Cleary","year":"2010","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"8","key":"zoi250608r58","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1111\/aogs.12433","article-title":"Maternal smoking in pregnancy and risk for congenital malformations: results of a Danish register-based cohort study.","volume":"93","author":"Leite","year":"2014","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"5","key":"zoi250608r59","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3390\/children10050811","article-title":"Birth defects associated with prenatal alcohol exposure-a review.","volume":"10","author":"Dylag","year":"2023","journal-title":"Children (Basel)"},{"issue":"1","key":"zoi250608r60","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1038\/npp.2014.147","article-title":"Developmental consequences of fetal exposure to drugs: what we know and what we still must learn.","volume":"40","author":"Ross","year":"2015","journal-title":"Neuropsychopharmacology"},{"issue":"3","key":"zoi250608r63","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1002\/pds.4387","article-title":"Bias from restricting to live births when estimating effects of prescription drug use on pregnancy complications: A simulation.","volume":"27","author":"Suarez","year":"2018","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"zoi250608r7","volume-title":"Creasy and Resnik\u2019s Maternal-Fetal Medicine: Principles and Practice","author":"Resnik","year":"2019"},{"key":"zoi250608r8","volume-title":"Embryogenesis and Fetal Development","author":"Cunningham","year":"2022"},{"key":"zoi250608r16","volume-title":"Goodman and Gilman\u2019s: The Pharmacological Basis of Therapeutics","author":"Mandell","year":"1990"},{"key":"zoi250608r40","volume-title":"The Developing Human: Clinically Oriented Embryology","author":"Persaud"},{"key":"zoi250608r43","volume-title":"Applying Quantitative Bias Analysis to Epidemiologic Data","author":"Lash","year":"2021","edition":"2nd ed"},{"key":"zoi250608r45","doi-asserted-by":"crossref","DOI":"10.1007\/978-0-387-84858-7","volume-title":"The Elements of Statistical Learning: Data Mining, Inference, and Prediction","author":"Hastie","year":"2009"},{"key":"zoi250608r53","volume-title":"Teratology","author":"Rasmussen","year":"2018","edition":"3rd ed"},{"key":"zoi250608r61","volume-title":"Teratogenic Medications","author":"Tsamantioti","year":"2024"},{"key":"zoi250608r62","year":"2021"},{"key":"zoi250608r64","volume-title":"Modern Epidemiology","year":"2021","edition":"4th ed"},{"key":"zoi250608r18","unstructured":"IBM Watson Health. IBM MarketScan research databases for health services researchers (white paper). Accessed June 9, 2025. https:\/\/ftpmirror.your.org\/pub\/misc\/ftp.software.ibm.com\/common\/ssi\/ecm\/hp\/en\/hpw03041usen\/watson-health-healthcare-providers-hp-white-paper-external-hpw03041usen-20180330.pdfhttps:\/\/www.ibm.com\/downloads\/cas\/0NKLE57Y"},{"key":"zoi250608r22","unstructured":"Sentinel Initiative. Characterizing pregnant women with and without evidence of heart failure and non-pregnant women with heart failure: a propensity score matched analysis. Accessed April 4, 2024. https:\/\/dev.sentinelsystem.org\/projects\/AP\/repos\/sentinel-analytic-packages\/browse?at=refs%2Fheads%2Fcder_mpl2p_wp029"},{"key":"zoi250608r29","unstructured":"Sentinel Initative. Cohort identification and descriptive analysis (CIDA) module, version 9.5.0. Accessed November 1, 2022. https:\/\/www.sentinelinitiative.org\/sites\/default\/files\/Drugs\/Assessments\/Report_Sentinel_cder_mpl1r_wp164_nsdp.pdf"},{"key":"zoi250608r32","unstructured":"Korn? EL, Graubard? BI. Confidence intervals for proportions with small expected number of positive counts estimated from survey data.? Surv Methodol. 1998;24:193-201."}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2836169\/osmundson_2025_oi_250608_1751315692.82508.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T15:00:48Z","timestamp":1752073248000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2836169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":64,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.19544","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]}}}