Fluoxetine updated on 07-01-2025

ASD (Autism spectrum disorder): Diagnosis

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.
S18377
R77462
Heuvelman, 2023 Autism spectrum disorder - Validated Read code list among primary care clinical and referral records - Mean age at end of follow-up 10.04 years, range 4–22 years during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 1.16 [0.90;1.49] -/4,767   -/16,330 - 4,767
ref
S18251
R76592
Suarez (Controls unexposed, discontinuers), 2022 Autism Spectrum Disorder - ≥ 2 dates with ICD-9 Dx 299.xx (except 299.1x) - At ≥ 1 year of age 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 1.33 [0.88;2.01] 209/26,595   38/7,773 247 26,595
ref
S18252
R76600
Suarez (Controls unexposed, general pop), 2022 Autism Spectrum Disorder - ≥ 2 dates with ICD-9 Dx 299.xx (except 299.1x) - At ≥ 1 year of age 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: no or not specified 1.12 [0.96;1.31]
excluded (control group)
211/26,659   11,425/2,984,014 11,636 26,659
ref
S10004
R35951
Ames, 2021 Autism spectrum disorder (ASD): diagnostic criteria on the Autism Diagnostic Observation Schedule and the full ASD diagnostic criteria on the ADI-R or one of three alternative criteria on the ADI-R (age NOS). 3 months (or more) before pregnancy or during pregnancy excluded case control unexposed, disease free Adjustment: No Monotherapy: no or not specified 1.70 [0.97;3.00] C
excluded (exposition period)
29/50   1,338/2,988 1,367 50
ref
S6550
R18031
Brown, 2017 Autism spectrum disorder (ASD) Diagnostic (ICD-9/OHIP: 299; ICD-10: F84) - Age: 4-10 years (mean: 4.95 years) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 0.71 [0.17;3.06] -/-   -/- - -
ref
S11337
R41744
Rai (Controls exposed to TCA), 2017 Autism spectrum disorder (ICD-9 (299), ICD-10 (F84), or DSM-IV (299) codes) - At 4-17 years during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No Monotherapy: no or not specified 0.50 [0.25;1.02] C
excluded (control group)
16/453   16/235 32 453
ref
S7481
R22396
Rai (Controls unexposed, disease free), 2017 Autism spectrum disorder (ICD-9 (299), ICD-10 (F84), or DSM-IV (299) codes) at 4-17 years during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No Monotherapy: no or not specified 1.75 [1.06;2.89] C
excluded (control group)
16/453   4,889/238,943 4,905 453
ref
S7825
R23235
Rai (Controls unexposed, sick), 2017 Autism spectrum disorder (ICD-9 (299), ICD-10 (F84), or DSM-IV (299) codes) at 4-17 years during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 1.42 [0.84;2.39] 16/453   353/12,325 369 453
ref
S7638
R22602
Viktorin (Controls unexposed, NOS), 2017 Autism spectrum disorder (ICD10- F84.0, F84.1, F84.2, F84.3, F84.4, F84.5, F84.8, or F84.9) at 7-8 years during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: no or not specified 1.04 [0.53;2.02]
excluded (control group)
9/458   1,524/172,646 1,533 458
ref
S7822
R23230
Viktorin (Controls unexposed, sick), 2017 Autism spectrum disorder (ICD10- F84.0, F84.1, F84.2, F84.3, F84.4, F84.5, F84.8, or F84.9) at 7-8 years during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 1.08 [0.53;2.21] 8/327   -/- - 327
ref
S7861
R23794
Bérard, 2016 Autism spectrum disorder (ICD-9 codes 299.0, 299.8, 299.9; ICD-10 codes F84.0, F84.1, F84.5, F84.8, F84.9) - Age : 0-11 years (mean: 4.0) 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 4.99 [1.45;17.05] 5/171   1,004/142,716 1,009 171
ref
Total 6 studies 1.28 [1.01;1.63] 1,625 32,313
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 Heuvelman, 2023Heuvelman, 2023 1.16[0.90; 1.49]-4,76743%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: criticalROB mesure: criticalROB reporting: low Suarez (Controls unexposed, discontinuers), 2022Suarez, 2022 1 1.33[0.88; 2.01]24726,59524%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Brown, 2017Brown, 2017 0.71[0.17; 3.06]--3%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Rai (Controls unexposed, sick), 2017Rai, 2017 2 1.42[0.84; 2.39]36945317%ROB confusion: unclearROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Viktorin (Controls unexposed, sick), 2017Viktorin, 2017 3 1.08[0.53; 2.21]-32710%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Bérard, 2016Bérard, 2016 4.99[1.45; 17.05]1,0091714%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: criticalROB reporting: moderate Total (6 studies) I2 = 20% 1.28[1.01; 1.63]1,62532,3130.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, discontinuers; 2: Controls unexposed, sick; 3: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.28[1.01; 1.63]1,62532,31320%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 6 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.96[0.29; 13.20]1,00917175%NABrown, 2017 Bérard, 2016 2 unexposed, sickunexposed, sick 1.22[1.01; 1.48]61632,1420%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 4 Tags Adjustment   - Yes  - Yes 1.28[1.01; 1.63]1,62532,31320%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 6 Monotherapy   - no or not specified  - no or not specified 1.21[1.00; 1.46]61632,1420%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 5   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 4.99[1.46; 17.11]1,009171 -NABérard, 2016 1 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 1.16[0.90; 1.49]-4,767 -NAHeuvelman, 2023 1   - old history of illness/treatment (> ...  - old history of illness/treatment (> 12 months before pregnancy) or not specified 1.29[0.85; 1.97]3697800%NARai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 2   - recent illness/treatment (during o ...  - recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 1.33[0.88; 2.01]24726,595 -NASuarez (Controls unexposed, discontinuers), 2022 1 All studiesAll studies 1.28[1.01; 1.63]1,62532,31320%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 60.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.92.00.8850.000Heuvelman, 2023Suarez (Controls unexposed, discontinuers), 2022Brown, 2017Rai (Controls unexposed, sick), 2017Viktorin (Controls unexposed, sick), 2017Bérard, 2016

Asymetry test p-value = 0.4464 (by Egger's regression)

slope=0.0672 (0.2155); intercept=0.7748 (0.9185); t=0.8436; p=0.4464

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 11337, 7481, 7638, 18252

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.36[0.92; 2.02]19,08327,74154%NASuarez (Controls unexposed, general pop), 2022 Brown, 2017 Rai (Controls unexposed, disease free), 2017 Viktorin (Controls unexposed, NOS), 2017 Bérard, 2016 5 unexposed, sick controlsunexposed, sick controls 1.22[1.01; 1.48]61632,1420%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.50[0.25; 1.02]32453 -NARai (Controls exposed to TCA), 2017 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Halvorsen (Autism spectrum disorder _ Cohort ...Halvorsen (Autism spectrum disorder _ Cohort studies) 0.97[0.53; 1.78]0%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT2 metaPregmetaPreg 1.28[1.01; 1.63]20%32,313----Heuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 60.510.01.0