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Additional studies were identified in a manual search of the reference lists. Two reviewers independently extracted data. A third reviewer checked the data. Estimates were pooled using a random\u2010effects model to calculate the summarized relative ratios (RR) and 95% confidence intervals (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1918 initially identified articles, 16 cohort studies were included. The offspring of pregnant women exposed to fluoxetine during the first trimester had a statistically increased risk of major malformations (RR\u00a0=\u00a01.18, 95% CI = 1.08\u20131.29), cardiovascular malformations (RR\u00a0=\u00a01.36, 95% CI = 1.17\u20131.59), septal defects (RR\u00a0=\u00a01.38, 95% CI = 1.19\u20131.61), and non\u2010septal defects (RR\u00a0=\u00a01.39, 95% CI = 1.12\u20131.73) with low heterogeneity in infants. There were no significant observations of other system\u2010specific malformations in the nervous system, eye, urogenital system, digestive system, respiratory system, or musculoskeletal system, respectively. There was no indication of publication bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results of this meta\u2010analysis indicate maternal fluoxetine use is associated with a slightly increased risk of cardiovascular malformations in infants. Health care providers and pregnant women must weigh the risk\u2013benefit potential of these drugs when making decisions about whether to treat with fluoxetine during pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.13321","type":"journal-article","created":{"date-parts":[[2017,5,17]],"date-time":"2017-05-17T05:02:48Z","timestamp":1494997368000},"page":"2134-2147","source":"Crossref","is-referenced-by-count":47,"title":["Fluoxetine and congenital malformations: a systematic review and meta\u2010analysis of cohort studies"],"prefix":"10.1111","volume":"83","author":[{"given":"Shan\u2010Yan","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi\u2010Jun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tie\u2010Ning","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zi\u2010Qi","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cai\u2010Xia","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9208-1685","authenticated-orcid":false,"given":"Yu\u2010Hong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology Shengjing Hospital of China Medical University  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,6,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkv1037"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/bph.13355"},{"key":"e_1_2_11_4_1","volume-title":"The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020","author":"Murray CL","year":"1996"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39189.662581.55"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000465192.34779.dc"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291703008286"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000116689.75396.5f"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7307.257"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.encep.2010.02.004"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674370404901103"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.12r07968"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-011-0251-1"},{"key":"e_1_2_11_14_1","first-page":"1","article-title":"The Expert Consensus Guideline Series. 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