Tricyclic antidepressants updated on 07-01-2025

Assisted deliveries (forceps, vacuum, ...)

R analysis
id Study   Lib. in paper Exposition period    Study type 
 Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S18445
R78330		 Lee (Controls exposed to SSRI), 2025 Instrumental delivery during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: TCA only 0.95 [0.68;1.34] C
excluded (control group) 		50/613   125/1,465 175 613
ref
S18410
R77731		 Lee (Controls unexposed, general pop), 2025 Instrumental delivery during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: TCA only 0.89 [0.67;1.20] 50/613   46,036/463,440 46,086 613
ref
S10931
R40651		 Pastuszak (Controls exposed to Fluoxetine), 1993 Forceps used 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No Matched Monotherapy: TCA only 0.79 [0.20;3.15] C
excluded (control group) 		6/42   4/23 10 42
ref
S10932
R40662		 Pastuszak (Controls unexposed, NOS), 1993 Forceps used 1st trimester excluded prospective cohort unexposed (general population or NOS) Adjustment: No Matched Monotherapy: TCA only 1.20 [0.34;4.29] C
excluded (exposition period) 		6/42   5/41 11 42
ref
Total 1 studies 0.89 [0.67;1.19] 46,086 613
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Lee (Controls unexposed, general pop), 2025Lee, 2025 1 0.89[0.67; 1.20]46,0866130%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate0.22.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, general pop;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.89[0.67; 1.19]46,086613 -NALee (Controls unexposed, general pop), 2025 1 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 0.89[0.67; 1.19]46,086613 -NALee (Controls unexposed, general pop), 2025 1 Tags Adjustment   - Yes  - Yes 0.89[0.67; 1.19]46,086613 -NALee (Controls unexposed, general pop), 2025 1 Monotherapy   - TCA only  - TCA only 0.89[0.67; 1.19]46,086613 -NALee (Controls unexposed, general pop), 2025 1 All studiesAll studies 0.89[0.67; 1.19]46,086613 -NALee (Controls unexposed, general pop), 2025 10.210.01.0

Publication bias and p-hacking diagnosis

funnel plot

Funnel plot not drawn. Less than 3 points.

Asymetry test p-value = NaN (by Egger's regression)

not enought points

p values plot

Funnel plot not drawn. Less than 3 points.

Sub-groups analysis using all included studies

excluded 10931, 18445

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 0.89[0.67; 1.19]46,086613 -NALee (Controls unexposed, general pop), 2025 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.95[0.68; 1.34]175613 -NALee (Controls exposed to SSRI), 2025 10.510.01.0