Fluoxetine updated on 07-01-2025

Early intrauterine deaths (< 22 weeks) / Spontaneous abortions

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.
S12956
R49165		 Kitchin, 2022 Miscarriage (pregnancy losses between 4-22 weeks) 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.36 [0.99;1.88] 57/170   18,013/72,109 18,070 170
ref
S7525
R22562		 Ozturk, 2016 Miscarriages at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.82 [0.22;15.35] C 1/10   15/261 16 10
ref
S7870
R23813		 Andersen, 2014 Miscarriage (O021 and O03) early pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.10 [1.01;1.21] -/4,111   139,210/1,256,956 - 4,111
ref
S8177
R25338		 Nakhai-Pour, 2010 Spontaneous abortions (< 20th week of gestation) during pregnancy (anytime or not specified) nested case control unexposed (general population or NOS) Adjustment: Yes Matched Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.44 [0.86;2.43] 22/-   5,102/- 5,124 -
ref
S6733
R19029		 Diav-Citrin, 2008 Miscarriage during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.27 [0.76;2.13] 41/346   97/1,467 138 346
ref
S7877
R23822		 Yaris, 2005 Spontaneous abortions during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 3.54 [0.70;17.87] C 2/17   9/248 11 17
ref
S15005
R61450		 Chambers, 1996 Spontaneous abortion 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.66 [0.89;3.09] C 23/169   22/254 45 169
ref
S6202
R16366		 Pastuszak (Controls exposed to TCA), 1993 Spontaneous abortion (NOS) 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No Matched Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.13 [0.43;2.96] C
excluded (control group) 		10/74   9/74 19 74
ref
S6952
R19658		 Pastuszak (Controls unexposed, NOS), 1993 Spontaneous abortion (NOS) 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Matched Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.90 [0.92;3.92] 19/128   10/128 29 128
ref
Total 8 studies 1.24 [1.07;1.43] 23,433 4,951
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 Kitchin, 2022Kitchin, 2022 1.36[0.99; 1.88]18,07017016%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Ozturk, 2016Ozturk, 2016 1.82[0.22; 15.35]16100%ROB confusion: criticalROB selection: unclearROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Andersen, 2014Andersen, 2014 1.10[1.01; 1.21]-4,11160%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Nakhai-Pour, 2010Nakhai-Pour, 2010 1.44[0.86; 2.43]5,124-7%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Diav-Citrin, 2008Diav-Citrin, 2008 1.27[0.76; 2.13]1383467%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: unclearROB reporting: moderate Yaris, 2005Yaris, 2005 3.54[0.70; 17.87]11171%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Chambers, 1996Chambers, 1996 1.66[0.89; 3.09]451695%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Pastuszak (Controls unexposed, NOS), 1993Pastuszak, 1993 1 1.90[0.92; 3.92]291284%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Total (8 studies) I2 = 13% 1.24[1.07; 1.43]23,4334,9510.510.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.26[1.01; 1.56]2394,78118%NAOzturk, 2016 Andersen, 2014 Diav-Citrin, 2008 Yaris, 2005 Chambers, 1996 Pastuszak (Controls unexposed, NOS), 1993 6 case control studiescase control studies 1.38[1.05; 1.82]23,1941700%NAKitchin, 2022 Nakhai-Pour, 2010 2 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.24[1.07; 1.43]23,4334,95113%NAKitchin, 2022 Ozturk, 2016 Andersen, 2014 Nakhai-Pour, 2010 Diav-Citrin, 2008 Yaris, 2005 Chambers, 1996 Pastuszak (Controls unexposed, NOS), 1993 8 Tags Adjustment   - No  - No 1.86[1.19; 2.89]1013240%NAOzturk, 2016 Yaris, 2005 Chambers, 1996 Pastuszak (Controls unexposed, NOS), 1993 4   - Yes  - Yes 1.13[1.04; 1.23]23,3324,6270%NAKitchin, 2022 Andersen, 2014 Nakhai-Pour, 2010 Diav-Citrin, 2008 4 MatchedMatched 1.58[1.04; 2.41]5,1531280%NANakhai-Pour, 2010 Pastuszak (Controls unexposed, NOS), 1993 2 Monotherapy   - no or not specified  - no or not specified 1.17[1.03; 1.33]18,2804,8237%NAKitchin, 2022 Ozturk, 2016 Andersen, 2014 Diav-Citrin, 2008 Yaris, 2005 Chambers, 1996 6   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.58[1.04; 2.41]5,1531280%NANakhai-Pour, 2010 Pastuszak (Controls unexposed, NOS), 1993 2 All studiesAll studies 1.24[1.07; 1.43]23,4334,95113%NAKitchin, 2022 Ozturk, 2016 Andersen, 2014 Nakhai-Pour, 2010 Diav-Citrin, 2008 Yaris, 2005 Chambers, 1996 Pastuszak (Controls unexposed, NOS), 1993 80.510.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.62.81.3050.000Kitchin, 2022Ozturk, 2016Andersen, 2014Nakhai-Pour, 2010Diav-Citrin, 2008Yaris, 2005Chambers, 1996Pastuszak (Controls unexposed, NOS), 1993

Asymetry test p-value = 0.0010 (by Egger's regression)

slope=0.0434 (0.0247); intercept=1.2219 (0.2063); t=5.9241; p=0.0010

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 6202

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.24[1.07; 1.43]162,6344,96413%NAKitchin, 2022 Ozturk, 2016 Andersen, 2014 Nakhai-Pour, 2010 Diav-Citrin, 2008 Yaris, 2005 Chambers, 1996 Pastuszak (Controls unexposed, NOS), 1993 8 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.13[0.43; 2.96]1974 -NAPastuszak (Controls exposed to TCA), 1993 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Xing (Spontaneous abortion)Xing (Spontaneous abortion) 1.88[1.15; 3.08]97%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT5 metaPregmetaPreg 1.24[1.07; 1.43]13%4,951----Kitchin, 2022 Ozturk, 2016 Andersen, 2014 Nakhai-Pour, 2010 Diav-Citrin, 2008 Yaris, 2005 Chambers, 1996 Pastuszak (Controls unexposed, NOS), 1993 80.510.01.0