Fluoxetine updated on 07-01-2025

Withdrawal syndrome / Neonatal abstinence syndrome / Poor neonatal adaptation

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.
S13124
R50031		 Marks (Controls exposed to Bupropion), 2021 Any adaptation syndrome (Neonatal abstinence syndrome (NAS) or Pediatric adaptation syndromes (PAS)) during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick excluded Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.30 [0.72;2.34]
excluded (control group) 		34/579   19/406 53 579
ref
S13125
R50042		 Marks (Controls unexposed, sick), 2021 Any adaptation syndrome (Neonatal abstinence syndrome (NAS) or Pediatric adaptation syndromes (PAS)) 3rd trimester retrospective cohort unexposed, sick Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 2.08 [1.27;3.42] -/275   -/- - 275
ref
S8156
R25123		 Dave, 2019 Neonatal abstinence syndrome 3rd trimester nested case control unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 5.45 [3.45;8.60] C 19/3,388   640/618,552 659 3,388
ref
S6193
R16327		 Levinson-Castiel, 2006 Severe neonatal abstinence syndrome (Finnegan score of 8 or higher) 3rd trimester retrospective cohort unexposed, disease free Adjustment: No Monotherapy: no or not specified 17.00 [0.65;446.05] C 1/12   0/60 1 12
ref
S15005
R61439		 Chambers, 1996 Poor neonatal adaptation late pregnancy prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 214.11 [12.79;3585.06] C 23/73   0/226 23 73
ref
Total 4 studies 6.30 [2.06;19.21] 683 3,748
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 Marks (Controls unexposed, sick), 2021Marks, 2021 1 2.08[1.27; 3.42]-27539%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Dave, 2019Dave, 2019 5.45[3.45; 8.60]6593,38840%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Levinson-Castiel, 2006Levinson-Castiel, 2006 17.00[0.65; 446.05]1129%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Chambers, 1996Chambers, 1996 214.11[12.79; 3585.06]237311%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 82% 6.30[2.06; 19.21]6833,7480.9500.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 15.58[0.74; 328.59]2436083%NAMarks (Controls unexposed, sick), 2021 Levinson-Castiel, 2006 Chambers, 1996 3 case control studiescase control studies 5.45[3.45; 8.60]6593,388 -NADave, 2019 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 20.24[1.99; 205.60]6833,47370%NADave, 2019 Levinson-Castiel, 2006 Chambers, 1996 3 unexposed, sickunexposed, sick 2.08[1.27; 3.41]-275 -NAMarks (Controls unexposed, sick), 2021 1 Tags Adjustment   - No  - No 20.24[1.99; 205.60]6833,47370%NADave, 2019 Levinson-Castiel, 2006 Chambers, 1996 3   - Yes  - Yes 2.08[1.27; 3.41]-275 -NAMarks (Controls unexposed, sick), 2021 1 Monotherapy   - no or not specified  - no or not specified 20.24[1.99; 205.60]6833,47370%NADave, 2019 Levinson-Castiel, 2006 Chambers, 1996 3   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 2.08[1.27; 3.41]-275 -NAMarks (Controls unexposed, sick), 2021 1 Unexposed sick   - recent illness/treatment (during o ...  - recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 2.08[1.27; 3.41]-275 -NAMarks (Controls unexposed, sick), 2021 1 All studiesAll studies 6.30[2.06; 19.21]6833,74882%NAMarks (Controls unexposed, sick), 2021 Dave, 2019 Levinson-Castiel, 2006 Chambers, 1996 40.51000.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-6.46.42.0000.000Marks (Controls unexposed, sick), 2021Dave, 2019Levinson-Castiel, 2006Chambers, 1996

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

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13124

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) Out of scale20.24[1.99; 205.60]6833,47370%NADave, 2019 Levinson-Castiel, 2006 Chambers, 1996 3 unexposed, sick controlsunexposed, sick controls 2.08[1.27; 3.41]-275 -NAMarks (Controls unexposed, sick), 2021 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.30[0.72; 2.34]53579 -NAMarks (Controls exposed to Bupropion), 2021 10.510.01.0