Selective Serotonin Reuptake Inhibitor (SSRI) updated on 10-20-2025

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Congenital malformations
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
All congenital malformations (majors, minors, majors and minors, or unspecified)1.10 [1.06, 1.14]0%26 studies125,19772,492low ROB1.43 [1.30; .]
Major congenital malformations1.10 [1.06, 1.15]0%23 studies117,51471,656low ROB1.44 [1.30; .]
Congenital heart defects1.17 [1.09, 1.25]11%21 studies51,954108,516low ROB1.61 [1.41; .]
Limb defects0.99 [0.83, 1.19]34%9 studies2,72626,054not evaluable ROB-
Nervous system anomalies1.09 [0.88, 1.34]0%10 studies6,34234,434low ROB-
Urinary malformations0.96 [0.78, 1.19]0%9 studies5,04221,704not evaluable ROB-
Ventricular septal defect1.04 [0.90, 1.22]39%10 studies15,83962,197low ROB-
Cardiac septal defects1.13 [1.05, 1.22]0%10 studies28,29061,508low ROB1.52 [1.26; .]
Respiratory system anomalies1.13 [0.76, 1.68]29%9 studies1,48626,784not evaluable ROB-
Atrial septal defect1.43 [1.17, 1.75]32%9 studies5,41325,338not evaluable ROB2.21 [1.61; .]
Digestive system anomalies1.04 [0.83, 1.30]0%8 studies3,82026,082not evaluable ROB-
Genital anomalies0.84 [0.66, 1.06]17%7 studies2,75820,813not evaluable ROB-
Oro-facial clefts0.95 [0.79, 1.13]0%6 studies2,66220,879not evaluable ROB-
Eye defects1.14 [0.87, 1.49]0%7 studies2,68223,686not evaluable ROB-
Abdominal wall defects1.87 [1.02, 3.43]0%5 studies1,58720,246not evaluable ROB3.15 [1.16; .]
Ear, face and neck anomalies1.03 [0.64, 1.67]0%6 studies1,29117,127not evaluable ROB-
Chromosomal abnormalities1.03 [0.69, 1.53]0%5 studies58317,025not evaluable ROB-
Craniosynostosis1.59 [1.17, 2.16]43%7 studies2,35552,532not evaluable ROB2.56 [1.61; .]
Hypospadias1.09 [0.95, 1.25]0%6 studies8,50249,941not evaluable ROB-
Microcephaly / Small head circumference for gestational age1.69 [0.62, 4.59]58%6 studies1,851710not evaluable ROB-
Minor congenital malformations2.74 [1.21, 6.19]0%2 studies26144not evaluable ROB4.91 [1.71; .]
Cleft palate0.98 [0.76, 1.27]0%4 studies4049,106not evaluable ROB-
Neural Tube Defects1.04 [0.75, 1.45]24%6 studies2,35117,986not evaluable ROB-
Omphalocele1.18 [0.75, 1.85]14%5 studies42445,874not evaluable ROB-
Ano-rectal atresia and stenosis1.35 [0.93, 1.96]36%5 studies1,90343,599not evaluable ROB-
Atrioventricular septal defect1.34 [1.03, 1.75]0%5 studies1,90740,230not evaluable ROB2.02 [1.21; .]
Cleft lip with or without cleft palate1.02 [0.70, 1.50]47%3 studies7047,158not evaluable ROB-
Club foot / Talipes equinovarus1.77 [1.36, 2.31]47%5 studies6,47139,873not evaluable ROB2.95 [2.07; .]
Diaphragmatic hernia1.29 [0.92, 1.83]0%3 studies4406,721not evaluable ROB-
Hypoplastic left heart (HLH/HLHS)1.48 [1.08, 2.04]0%4 studies6793,101not evaluable ROB2.33 [1.38; .]
Limb reduction defects (LRD)1.14 [0.80, 1.62]0%4 studies2,69843,601not evaluable ROB-
Coarctation of aorta1.35 [0.97, 1.88]27%3 studies1,041415not evaluable ROB-
Eye, ear, face and neck malformations0.83 [0.46, 1.49]0%2 studies1103,788not evaluable ROB-
Gastroschisis1.67 [1.09, 2.55]53%3 studies42437,243not evaluable ROB2.73 [1.42; .]
Hirschsprung's disease1.76 [1.07, 2.91]-1 study60019,807not evaluable ROB2.92 [1.33; .]
Hydrocephaly3.69 [0.24, 56.44]92%2 studies72172not evaluable ROB-
Oesophageal atresia with or without tracheo-oesophageal fistula2.70 [0.69, 10.53]74%3 studies4436,727not evaluable ROB-
Patent ductus arterious3.07 [1.65, 5.72]-1 study1222,701not evaluable ROB5.59 [2.68; .]
Severe congenital heart defect1.46 [1.01, 2.11]0%2 studies2,9672,894not evaluable ROB2.28 [1.11; .]
Spina bifida0.94 [0.65, 1.36]0%2 studies29805not evaluable ROB-
Transposition of the great vessels1.13 [0.79, 1.61]0%3 studies8557,078not evaluable ROB-
Atresia or stenosis of other parts of small intestine7.19 [0.31, 164.13]86%2 studies3516,727not evaluable ROB-
Ebstein's anomaly2.08 [0.32, 13.46]85%2 studies173238not evaluable ROB-
Multicystic renal dysplasia1.83 [0.71, 4.70]81%2 studies1,46736,883not evaluable ROB-
Pulmonary valve stenosis1.80 [1.41, 2.29]0%2 studies772106not evaluable ROB2.99 [2.18; .]
Tetralogy of Fallot2.07 [1.10, 3.90]63%2 studies428107not evaluable ROB3.57 [1.44; .]
Aortic valve atresia/stenosis--0 study-
Congenital hydronephrosis--0 study-
Hip dislocation and/or dysplasia--0 study-
Pulmonary valve atresia--0 study-
Syndactyly--0 study-
15 non statistically significant endpoints reported in only one study

Growth parameters and prematurity
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Preterm (< 37 weeks)1.35 [1.24, 1.47]71%43 studies237,18086,924low ROB2.04 [1.79; .]
Low birth weight (< 2500g)1.29 [1.16, 1.43]58%23 studies85,87747,510low ROB1.90 [1.58; .]
Small for gestational age (weight)1.18 [1.02, 1.37]82%21 studies278,43274,962probable ROB1.65 [1.18; .]
Large for gestational age (weight)0.90 [0.74, 1.09]72%9 studies88,04927,083not evaluable ROB-
Macrosomia (> 4000g)0.87 [0.82, 0.93]0%4 studies52,65413,445not evaluable ROB1.55 [.; 1.36]
Very preterm (28 to 32 weeks)0.90 [0.64, 1.25]74%6 studies1,29851,664not evaluable ROB-
Extremely preterm (< 28 weeks)0.85 [0.57, 1.27]0%2 studies24818,067not evaluable ROB-
Small for gestational age (length)1.63 [0.41, 6.52]32%2 studies1,88521not evaluable ROB-
Very low birth weight (< 1500g)1.48 [0.42, 5.21]64%2 studies916,511not evaluable ROB-
2 non statistically significant endpoints reported in only one study

Maternal consequences
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Caesarean1.22 [0.98, 1.53]96%22 studies174,32642,002low ROB-
Preeclampsia1.33 [1.13, 1.56]73%16 studies16,23533,583critical ROB1.99 [1.52; .]
Postpartum hemorrhage1.24 [1.14, 1.35]62%9 studies62,34538,238not evaluable ROB1.78 [1.54; .]
Assisted deliveries (forceps, vacuum, ...)1.24 [0.81, 1.91]94%4 studies55,2374,228not evaluable ROB-
Gestational diabetes1.17 [0.82, 1.66]12%3 studies20,9285,310not evaluable ROB-
Placenta previa--0 study-
Polyhydramnios1.60 [1.05, 2.46]-1 study1,025358not evaluable ROB2.59 [1.27; .]
4 non statistically significant endpoints reported in only one study

Neonatal disorders
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Neonatal medical care1.84 [1.63, 2.07]86%36 studies106,88961,231critical ROB3.07 [2.64; .]
Low Apgar score (< 7) (at 5 min)1.90 [1.58, 2.29]58%19 studies36,54760,446low ROB3.20 [2.53; .]
Withdrawal syndrome / Neonatal abstinence syndrome / Poor neonatal adaptation3.50 [2.15, 5.69]78%14 studies92241,135low ROB6.45 [3.72; .]
Persistent pulmonary hypertension1.73 [1.26, 2.37]61%13 studies7,274111,458probable ROB2.84 [1.83; .]
Low Apgar score (< 7) (at 1 min)1.84 [1.38, 2.46]40%6 studies16,5492,230not evaluable ROB3.09 [2.10; .]
Neonatal disorders (as a whole)1.71 [1.54, 1.90]0%6 studies162,2961,755not evaluable ROB2.82 [2.46; .]
Jaundice / Icterus0.82 [0.71, 0.94]0%4 studies27,8025,553not evaluable ROB1.74 [.; 1.31]
Neonatal hypoglycemia1.30 [1.09, 1.54]22%6 studies18,18617,971not evaluable ROB1.92 [1.40; .]
Neonatal death (< 28 days of life)1.11 [0.81, 1.52]0%4 studies4,17619,283not evaluable ROB-
Neonatal infections1.20 [0.95, 1.50]0%4 studies2,71225,517not evaluable ROB-
Neonatal tachypnea1.59 [1.06, 2.37]55%4 studies16,90219,455not evaluable ROB2.55 [1.32; .]
Feeding difficulty1.11 [0.98, 1.27]42%3 studies15,59821,907not evaluable ROB-
Neonatal intracranial hemorrhage0.83 [0.52, 1.32]12%3 studies1,96817,776not evaluable ROB-
Very low Apgar score (< 5) (at 1 min)1.57 [0.84, 2.96]0%2 studies49269not evaluable ROB-
Very low Apgar score (< 5) (at 5 min)2.45 [1.98, 3.03]0%3 studies1,3657,794not evaluable ROB4.33 [3.36; .]
Low Apgar score (< 7) (NOS)2.28 [1.27, 4.10]-1 study4,983500not evaluable ROB3.99 [1.85; .]
Necrotizing enterocolitis0.31 [0.04, 2.25]0%2 studies5101not evaluable ROB-
Fetal distress6.00 [1.88, 19.16]-1 study47874not evaluable ROB11.48 [3.16; .]
Infant health status 1.37 [1.25, 1.51]-1 study10,6382,783not evaluable ROB2.08 [1.80; .]
Metabolic disorders in neonate/infant1.61 [1.15, 2.26]-1 study1,805874not evaluable ROB2.60 [1.55; .]
1 non statistically significant endpoints reported in only one study

Long term consequences
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Child/Infant death (> 28 days of life)1.37 [1.09, 1.72]0%4 studies7,8865,229not evaluable ROB2.08 [1.41; .]
Child/Infant weight abnormalities (> 1 year)1.02 [0.70, 1.49]0%2 studies198not evaluable ROB-
1 non statistically significant endpoints reported in only one study

Intrauterine deaths
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Early intrauterine deaths (< 22 weeks) / Spontaneous abortions1.42 [1.17, 1.71]82%17 studies29,43841,026critical ROB2.18 [1.63; .]
Late intrauterine deaths (> 22 weeks) / Stillbirths1.15 [0.97, 1.35]0%11 studies6,61723,736low ROB-
Elective/induced termination of pregnancy1.82 [1.48, 2.24]71%8 studies39416,741not evaluable ROB3.05 [2.33; .]
Therapeutic terminations of pregnancy2.70 [1.27, 5.74]76%7 studies921,599serious ROB4.84 [1.86; .]
Ectopic pregnancy1.00 [0.91, 1.09]0%3 studies3,81732,153not evaluable ROB-
Intrauterine deaths (as a whole or unspecified)1.33 [0.99, 1.79]63%5 studies28,8454,480not evaluable ROB-
Perinatal death1.22 [1.00, 1.47]0%3 studies13332,285not evaluable ROB1.73 [1.07; .]

Neuro-developmental disorders
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
ASD (Autism spectrum disorder): Diagnosis/Risk1.32 [1.16, 1.50]66%18 studies46,614206,609low ROB1.98 [1.60; .]
ASD (Autism spectrum disorder): Diagnosis1.32 [1.16, 1.51]68%17 studies46,614206,540low ROB1.98 [1.59; .]
ADHD (Attention deficit hyperactivity disorder): Diagnosis/Risk1.25 [1.09, 1.43]81%14 studies140,185182,301low ROB1.81 [1.40; .]
ADHD (Attention deficit hyperactivity disorder): Diagnosis1.26 [1.09, 1.44]82%13 studies140,185182,279low ROB1.82 [1.42; .]
Psychomotor developmental disorders/delay1.36 [1.10, 1.67]17%10 studies904131,025low ROB2.06 [1.44; .]
Language disorders/delay1.18 [1.09, 1.27]0%6 studies5,642130,940not evaluable ROB1.64 [1.41; .]
Cognitive developmental disorders/delay (3-6 years old)1.23 [0.97, 1.56]3%6 studies380115,388not evaluable ROB-
Cognitive developmental disorders/delay (< 3 years old)1.24 [0.65, 2.36]48%5 studies12172not evaluable ROB-
Childhood autism (F84.0)1.03 [0.73, 1.46]0%2 studies274,653not evaluable ROB-
Learning disorders 0.86 [0.68, 1.10]0%2 studies499130,656not evaluable ROB-
Neuro-developmental disorders (as a whole)1.14 [1.07, 1.20]0%3 studies11,152117,350not evaluable ROB1.53 [1.36; .]
ADHD (Attention deficit hyperactivity disorder): Risk0.60 [0.39, 0.94]0%2 studies150not evaluable ROB2.69 [.; 1.33]
ASD (Autism spectrum disorder): Risk1.28 [0.69, 2.38]0%2 studies69not evaluable ROB-
Cognitive developmental disorders/delay (> 6 years old)1.16 [0.80, 1.68]58%3 studies8128,772not evaluable ROB-
Severe cognitive developmental delay (Mental retardation) (3-6 years old)1.02 [0.71, 1.47]0%2 studies380115,079not evaluable ROB-
Severe cognitive developmental delay (Mental retardation) (> 6 years old)1.16 [0.80, 1.68]58%3 studies8128,772not evaluable ROB-
1 non statistically significant endpoints reported in only one study

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