Paroxetine updated on 07-01-2025

Low Apgar score (< 7) (at 5 min)

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.
S18437
R78174		 Lee (Controls exposed to TCAs), 2025 5-minute Apgar score<7 during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.72 [0.04;13.18] C
excluded (control group) 		0/77   5/613 5 77
ref
S18419
R77932		 Lee (Controls unexposed, general pop), 2025 5-minute Apgar score<7 during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.75 [0.11;28.29] C 0/77   1,721/463,440 1,721 77
ref
S18223
R76455		 Martin, 2024 Low Apgar score at 5 min (<7) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.59 [1.13;2.24] 39/1,606   30,996/2,078,011 31,035 1,606
ref
S13126
R50051		 Marks (Controls exposed to Bupropion), 2021 5 Min APGAR <7 during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.39 [0.64;3.02] C 9/55   50/406 59 55
ref
S7698
R22854		 Kivistö, 2016 Low (<7) Apgar score at 5 min during pregnancy (anytime or not specified) retrospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.04 [0.14;7.70] -/32   780/24,402 - 32
ref
S7180
R20233		 Colvin, 2011 APGAR 5-minutes <6 during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.58 [0.91;2.74] 13/685   1,144/94,561 1,157 685
ref
Total 5 studies 1.55 [1.19;2.03] 33,972 2,455
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 1.75[0.11; 28.29]1,721771%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Martin, 2024Martin, 2024 1.59[1.13; 2.24]31,0351,60662%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Marks (Controls exposed to Bupropion), 2021Marks, 2021 2 1.39[0.64; 3.02]595512%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Kivistö, 2016Kivistö, 2016 1.04[0.14; 7.70]-322%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Colvin, 2011Colvin, 2011 1.58[0.91; 2.74]1,15768524%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 0% 1.55[1.19; 2.03]33,9722,4550.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, general pop; 2: Controls exposed to Bupropion;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.55[1.19; 2.03]33,9722,4550%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.58[1.18; 2.10]33,9132,4000%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Colvin, 2011 4 exposed to other treatment, sickexposed to other treatment, sick 1.39[0.64; 3.02]5955 -NAMarks (Controls exposed to Bupropion), 2021 1 Tags Adjustment   - No  - No 1.52[0.98; 2.37]2,9378170%NALee (Controls unexposed, general pop), 2025 Marks (Controls exposed to Bupropion), 2021 Colvin, 2011 3   - Yes  - Yes 1.57[1.12; 2.20]31,0351,6380%NAMartin, 2024 Kivistö, 2016 2 Monotherapy   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.54[1.14; 2.10]32,8151,7700%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 4   - substance alone among the specific ...  - substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.58[0.91; 2.74]1,157685 -NAColvin, 2011 1 All studiesAll studies 1.55[1.19; 2.03]33,9722,4550%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 50.55.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.33.81.7030.000Lee (Controls unexposed, general pop), 2025Martin, 2024Marks (Controls exposed to Bupropion), 2021Kivistö, 2016Colvin, 2011

Asymetry test p-value = 0.2939 (by Egger's regression)

slope=0.5001 (0.0577); intercept=-0.2391 (0.1884); t=1.2691; p=0.2939

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 18437

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.58[1.18; 2.10]34,6842,4000%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Colvin, 2011 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.33[0.63; 2.82]641320%NALee (Controls exposed to TCAs), 2025 Marks (Controls exposed to Bupropion), 2021 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Vlenterie (Low 5-min Apgar score)Vlenterie (Low 5-min Apgar score) 2.40[0.70; 7.80]-U,GPunexposed (general population or NOS)Anyduring pregnancy (anytime or not specified)studies TTT8 Vlenterie (Low 5-min Apgar score)Vlenterie (Low 5-min Apgar score) 1.90[0.80; 4.60]-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT8 Xing (Low Apgar score at 5 min)Xing (Low Apgar score at 5 min) 1.53[0.90; 2.61]0%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT2 metaPregmetaPreg 1.55[1.19; 2.03]0%2,455----Lee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 50.510.01.0