{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T05:07:13Z","timestamp":1793855233844,"version":"4.6.1"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"Importance<\/jats:title>Psychiatric disorders are common among female individuals of reproductive age. While antipsychotic medication use is increasing, the safety of such medications in pregnancy is an area with large evidence gaps.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the risk of first-trimester antipsychotic exposure with respect to congenital malformations, focusing on individual drugs and specific malformation subtypes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used data from nationwide health registers from the 5 Nordic countries and the US and spanned 1996 to 2018. The Nordic cohort included all pregnancies resulting in singleton live-born infants, and the US cohort consisted of publicly insured mothers linked to their live-born infants nested in the nationwide Medicaid Analytic eXtract. Data were analyzed from November 2020 to April 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>One or more first-trimester dispensing of any atypical, any typical, and individual antipsychotic drugs.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Any major congenital malformation and specific malformation subtypes previously suggested to be associated with antipsychotic exposure in utero: cardiovascular malformations, oral clefts, neural tube defects, hip dysplasia, limb reduction defects, anorectal atresia\/stenosis, gastroschisis, hydrocephalus, other specific brain anomalies, and esophageal disorders. Propensity score stratification was used to control for potential confounders. Pooled adjusted estimates were calculated using indirect standardization.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 6\u202f455\u202f324 unexposed mothers (mean maternal age range across countries: 24-31 years), 21\u202f751 mothers exposed to atypical antipsychotic drugs (mean age range, 26-31 years), and 6371 mothers exposed to typical antipsychotic drugs (mean age range, 27-32 years) were included in the study cohort. Prevalence of any major malformation was 2.7% (95% CI, 2.7%-2.8%) in unexposed infants, 4.3% (95% CI, 4.1%-4.6%) in infants with atypical antipsychotic drug exposure, and 3.1% (95% CI, 2.7%-3.5%) in infants with typical antipsychotic drug exposure in utero. Among the most prevalent exposure-outcome combinations, adjusted relative risks (aRR) were generally close to the null. One exception was olanzapine exposure and oral cleft (aRR, 2.1 [95% CI, 1.1-4.3]); however, estimates varied across sensitivity analyses. Among moderately prevalent combinations, increased risks were observed for gastroschisis and other specific brain anomalies after atypical antipsychotic exposure (aRR, 1.5 [95% CI, 0.8-2.6] and 1.9 [95% CI, 1.1-3.0]) and for cardiac malformations after chlorprothixene exposure (aRR, 1.6 [95% CI, 1.0-2.7]). While the association direction was consistent across sensitivity analyses, confidence intervals were wide, prohibiting firm conclusions.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, considering the evidence from primary and sensitivity analyses and inevitable statistical noise for very rare exposure-outcome combinations, in utero antipsychotic exposure generally was not meaningfully associated with an increased risk of malformations. The observed increased risks of oral clefts associated with olanzapine, gastroschisis, and other specific brain anomalies with atypical antipsychotics and cardiac malformations with chlorprothixene requires confirmation as evidence continues to accumulate.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2022.4109","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T16:01:37Z","timestamp":1670428897000},"page":"156","source":"Crossref","is-referenced-by-count":71,"title":["Association of In Utero Antipsychotic Medication Exposure With Risk of Congenital Malformations in Nordic Countries and the US"],"prefix":"10.1001","volume":"80","author":[{"given":"Krista F.","family":"Huybrechts","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loreen","family":"Straub","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e4r","family":"Karlsson","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Pazzagli","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Furu","sequence":"additional","affiliation":[{"name":"Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway"},{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Research Centre for Child Psychiatry, University of Turku, Turku, Finland"},{"name":"Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Hernandez-Diaz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette","family":"N\u00f8rgaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Zoega","sequence":"additional","affiliation":[{"name":"School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia"},{"name":"Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian T.","family":"Bateman","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn E.","family":"Cesta","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway"},{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarit K.","family":"Leinonen","sequence":"additional","affiliation":[{"name":"Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Reutfors","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randi M.","family":"Selmer","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Suarez","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinna Pilgaard","family":"Ulrichsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle","family":"Kieler","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden"},{"name":"Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"yoi220083r1","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1016\/j.ajog.2010.07.007","article-title":"Mental health and access to services among US women of reproductive age.","volume":"203","author":"Farr","year":"2010","journal-title":"Am J Obstet Gynecol"},{"issue":"8","key":"yoi220083r2","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1089\/jwh.2011.3466","article-title":"Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005-2009.","volume":"21","author":"Ko","year":"2012","journal-title":"J Womens Health (Larchmt)"},{"issue":"12","key":"yoi220083r3","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1002\/jclp.v65:12","article-title":"Postpartum depression: what we know.","volume":"65","author":"O\u2019Hara","year":"2009","journal-title":"J Clin Psychol"},{"issue":"1","key":"yoi220083r4","doi-asserted-by":"publisher","first-page":"62","DOI":"10.3390\/neurolint14010005","article-title":"Antipsychotic use in pregnancy: patient mental health challenges, teratogenicity, pregnancy complications, and postnatal risks.","volume":"14","author":"Edinoff","year":"2022","journal-title":"Neurol Int"},{"key":"yoi220083r5","first-page":"13","article-title":"Use of atypical antipsychotics in refractory depression and anxiety.","volume":"66","author":"Nemeroff","year":"2005","journal-title":"J Clin Psychiatry"},{"issue":"6","key":"yoi220083r6","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1176\/appi.ajp.2012.12030367","article-title":"The last therapeutic orphan: the pregnant woman.","volume":"169","author":"Wisner","year":"2012","journal-title":"Am J Psychiatry"},{"issue":"8","key":"yoi220083r7","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1176\/appi.ajp.2007.06111886","article-title":"Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes.","volume":"164","author":"Newport","year":"2007","journal-title":"Am J Psychiatry"},{"issue":"1","key":"yoi220083r8","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s40360-019-0330-x","article-title":"Use of long acting injectable aripiprazole before and through pregnancy in bipolar disorder: a case report.","volume":"20","author":"Ballester-Gracia","year":"2019","journal-title":"BMC Pharmacol Toxicol"},{"issue":"1","key":"yoi220083r9","first-page":"49","article-title":"Extended release quetiapine fumarate and pregnancy.","volume":"15","author":"T\u00e9nyi","year":"2013","journal-title":"Neuropsychopharmacol Hung"},{"issue":"7","key":"yoi220083r10","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1055\/s-00000054","article-title":"Aripiprazole use in early pregnancy: a case report.","volume":"45","author":"Widschwendter","year":"2012","journal-title":"Pharmacopsychiatry"},{"key":"yoi220083r11","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.schres.2019.11.019","article-title":"Atypical antipsychotic use during pregnancy and birth defect risk: National Birth Defects Prevention Study, 1997-2011.","volume":"215","author":"Anderson","year":"2020","journal-title":"Schizophr Res"},{"issue":"3","key":"yoi220083r12","doi-asserted-by":"publisher","first-page":"317","DOI":"10.4088\/JCP.v66n0307","article-title":"Safety of haloperidol and penfluridol in pregnancy: a multicenter, prospective, controlled study.","volume":"66","author":"Diav-Citrin","year":"2005","journal-title":"J Clin Psychiatry"},{"issue":"4","key":"yoi220083r13","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00737-021-01115-6","article-title":"Reproductive safety of aripiprazole: data from the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics.","volume":"24","author":"Freeman","year":"2021","journal-title":"Arch Womens Ment Health"},{"issue":"5","key":"yoi220083r14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0094788","article-title":"A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old babies.","volume":"9","author":"Kulkarni","year":"2014","journal-title":"PLoS One"},{"issue":"4","key":"yoi220083r15","doi-asserted-by":"publisher","first-page":"444","DOI":"10.4088\/JCP.v66n0406","article-title":"Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study.","volume":"66","author":"McKenna","year":"2005","journal-title":"J Clin Psychiatry"},{"issue":"12","key":"yoi220083r16","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1176\/appi.ajp.2018.18010098","article-title":"Risk of major malformations in infants following first-trimester exposure to quetiapine.","volume":"175","author":"Cohen","year":"2018","journal-title":"Am J Psychiatry"},{"issue":"10","key":"yoi220083r17","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.3390\/ph6101221","article-title":"The use of central nervous system active drugs during pregnancy.","volume":"6","author":"K\u00e4ll\u00e9n","year":"2013","journal-title":"Pharmaceuticals (Basel)"},{"issue":"7","key":"yoi220083r18","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1007\/s40264-016-0413-1","article-title":"Signal of gastrointestinal congenital malformations with antipsychotics after minimising competition bias: a disproportionality analysis using data from Vigibase(\u00ae).","volume":"39","author":"Montastruc","year":"2016","journal-title":"Drug Sa"},{"issue":"4","key":"yoi220083r19","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s00213-013-3060-6","article-title":"Effects of prenatal exposure to atypical antipsychotics on postnatal development and growth of infants: a case-controlled, prospective study.","volume":"228","author":"Peng","year":"2013","journal-title":"Psychopharmacology (Berl)"},{"issue":"9","key":"yoi220083r20","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1001\/jamapsychiatry.2016.1520","article-title":"Antipsychotic use in pregnancy and the risk for congenital malformations.","volume":"73","author":"Huybrechts","year":"2016","journal-title":"JAMA Psychiatry"},{"issue":"11","key":"yoi220083r21","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1007\/s00228-021-03169-y","article-title":"Second-generation antipsychotic use during pregnancy and risk of congenital malformations.","volume":"77","author":"Ellfolk","year":"2021","journal-title":"Eur J Clin Pharmacol"},{"issue":"4","key":"yoi220083r22","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1097\/JCP.0b013e318295fe12","article-title":"Atypical antipsychotic drugs and pregnancy outcome: a prospective, cohort study.","volume":"33","author":"Habermann","year":"2013","journal-title":"J Clin Psychopharmacol"},{"issue":"2-3","key":"yoi220083r23","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.schres.2016.07.023","article-title":"Risks associated with antipsychotic treatment in pregnancy: comparative cohort studies based on electronic health records.","volume":"176","author":"Petersen","year":"2016","journal-title":"Schizophr Res"},{"issue":"1","key":"yoi220083r24","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s00737-008-0044-3","article-title":"Atypical antipsychotic use in pregnancy: a retrospective review.","volume":"12","author":"Wichman","year":"2009","journal-title":"Arch Womens Ment Health"},{"issue":"7","key":"yoi220083r25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003062","article-title":"Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study.","volume":"3","author":"Sadowski","year":"2013","journal-title":"BMJ Open"},{"issue":"7","key":"yoi220083r26","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1111\/pcn.2019.73.issue-7","article-title":"Schizophrenia and motherhood.","volume":"73","author":"Gentile","year":"2019","journal-title":"Psychiatry Clin Neurosci"},{"issue":"4","key":"yoi220083r27","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s40263-018-0517-5","article-title":"The safety of second-generation antipsychotics during pregnancy: a clinically focused review.","volume":"32","author":"Damkier","year":"2018","journal-title":"CNS Drugs"},{"issue":"3","key":"yoi220083r28","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s11920-018-0882-2","article-title":"Weighing the risks: the management of bipolar disorder during pregnancy.","volume":"20","author":"Thomson","year":"2018","journal-title":"Curr Psychiatry Rep"},{"issue":"9","key":"yoi220083r29","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1517\/14656566.2015.1041501","article-title":"Antipsychotic use in pregnancy.","volume":"16","author":"Kulkarni","year":"2015","journal-title":"Expert Opin Pharmacother"},{"key":"yoi220083r30","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.jad.2017.12.021","article-title":"Aripiprazole use during pregnancy, peripartum and lactation: a systematic literature search and review to inform clinical practice.","volume":"228","author":"Cuomo","year":"2018","journal-title":"J Affect Disord"},{"issue":"1","key":"yoi220083r31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00737-016-0670-0","article-title":"A review of the safety of clozapine during pregnancy and lactation.","volume":"20","author":"Mehta","year":"2017","journal-title":"Arch Womens Ment Health"},{"issue":"4","key":"yoi220083r32","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1111\/bcpt.2015.116.issue-4","article-title":"Pregnancy exposure to olanzapine, quetiapine, risperidone, aripiprazole and risk of congenital malformations: a systematic review.","volume":"116","author":"Ennis","year":"2015","journal-title":"Basic Clin Pharmacol Toxicol"},{"issue":"5","key":"yoi220083r33","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1097\/AOG.0000000000000759","article-title":"Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy.","volume":"125","author":"Coughlin","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"11","key":"yoi220083r34","doi-asserted-by":"publisher","first-page":"4101","DOI":"10.1111\/bcp.v87.11","article-title":"Prenatal exposure to antipsychotic agents and the risk of congenital malformations in children: a systematic review and meta-analysis.","volume":"87","author":"Wang","year":"2021","journal-title":"Br J Clin Pharmacol"},{"issue":"5","key":"yoi220083r35","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.21f14252","article-title":"Major congenital malformations associated with exposure to second-generation antipsychotic drugs during pregnancy.","volume":"82","author":"Andrade","year":"2021","journal-title":"J Clin Psychiatry"},{"issue":"1","key":"yoi220083r36","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.jaclp.2021.08.011","article-title":"Long-acting injectable antipsychotic medications in pregnancy: a review.","volume":"63","author":"O\u2019Sullivan","year":"2022","journal-title":"J Acad Consult Liaison Psychiatry"},{"issue":"1","key":"yoi220083r37","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s40501-019-0165-5","article-title":"Use of antipsychotic drugs during pregnancy.","volume":"6","author":"Betcher","year":"2019","journal-title":"Curr Treat Options Psychiatry"},{"issue":"3","key":"yoi220083r38","doi-asserted-by":"publisher","first-page":"247","DOI":"10.2165\/00002018-200730030-00006","article-title":"Evaluating the postmarketing experience of risperidone use during pregnancy: pregnancy and neonatal outcomes.","volume":"30","author":"Coppola","year":"2007","journal-title":"Drug Saf"},{"issue":"10","key":"yoi220083r39","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1177\/070674370204701008","article-title":"Antipsychotic medication during pregnancy and lactation in women with schizophrenia: evaluating the risk.","volume":"47","author":"Patton","year":"2002","journal-title":"Can J Psychiatry"},{"issue":"10","key":"yoi220083r40","doi-asserted-by":"publisher","first-page":"665","DOI":"10.7326\/M18-0338","article-title":"\u00df-Blocker use in pregnancy and the risk for congenital malformations: an international cohort study.","volume":"169","author":"Bateman","year":"2018","journal-title":"Ann Intern Med"},{"issue":"2","key":"yoi220083r41","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1001\/jamapsychiatry.2017.3644","article-title":"Association between methylphenidate and amphetamine use in pregnancy and risk of congenital malformations: a cohort study from the international pregnancy safety study consortium.","volume":"75","author":"Huybrechts","year":"2018","journal-title":"JAMA Psychiatry"},{"issue":"6","key":"yoi220083r42","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":"25","key":"yoi220083r43","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"issue":"1","key":"yoi220083r44","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":"2","key":"yoi220083r45","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/EDE.0000000000000595","article-title":"A propensity-score-based fine stratification approach for confounding adjustment when exposure is infrequent.","volume":"28","author":"Desai","year":"2017","journal-title":"Epidemiology"},{"issue":"2","key":"yoi220083r47","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1002\/(ISSN)1096-9926","article-title":"The interaction between dysmorphology and epidemiology: methodologic issues of lumping and splitting.","volume":"45","author":"Khoury","year":"1992","journal-title":"Teratology"},{"issue":"9","key":"yoi220083r48","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1001\/jamapsychiatry.2016.1538","article-title":"Use of antipsychotics during pregnancy: pregnant women get sick-sick women get pregnant.","volume":"73","author":"Wisner","year":"2016","journal-title":"JAMA Psychiatry"},{"issue":"11","key":"yoi220083r49","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1002\/bdra.23329","article-title":"Birth defects data from population-based birth defects surveillance programs in the United States, 2007 to 2011: highlighting orofacial clefts.","volume":"100","author":"Mai","year":"2014","journal-title":"Birth Defects Res A Clin Mol Teratol"},{"issue":"2","key":"yoi220083r50","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1080\/00031305.2016.1154108","article-title":"The ASA statement on P values: context, process, and purpose.","volume":"70","author":"Wasserstein","year":"2016","journal-title":"Am Stat"},{"issue":"7748","key":"yoi220083r51","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1038\/d41586-019-00857-9","article-title":"Scientists rise up against statistical significance.","volume":"567","author":"Amrhein","year":"2019","journal-title":"Nature"},{"key":"yoi220083r46","first-page":"1208","volume-title":"Pharmacoepidemiology","author":"Horton","year":"2019","edition":"6th ed"}],"container-title":["JAMA Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/articlepdf\/2799269\/jamapsychiatry_huybrechts_2022_oi_220083_1675180149.42038.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T16:33:59Z","timestamp":1675269239000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2799269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":51,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapsychiatry.2022.4109","relation":{},"ISSN":["2168-622X"],"issn-type":[{"value":"2168-622X","type":"print"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}