Paroxetine updated on 07-01-2025

Preterm (< 37 weeks)

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
R78169		 Lee (Controls exposed to TCAs), 2025 Preterm birth (infant born at gestational age <37 weeks) 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, ...) 0.39 [0.12;1.27] C
excluded (control group) 		3/77   58/613 61 77
ref
S18419
R77927		 Lee (Controls unexposed, general pop), 2025 Preterm birth (infant born at gestational age <37 weeks) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.34 [0.11;1.09] 3/77   28,543/463,440 28,546 77
ref
S18223
R76453		 Martin, 2024 Preterm delivery (delivery at <259 days (37 weeks’)) 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, ...) 1.12 [0.96;1.30] 208/2,794   119,950/2,408,707 120,158 2,794
ref
S13126
R50052		 Marks (Controls exposed to Bupropion), 2021 Preterm Birth during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.96 [0.43;2.14] C 8/55   61/406 69 55
ref
S7698
R22855		 Kivistö, 2016 Preterm delivery (birth before 37 completed weeks) during pregnancy (anytime or not specified) retrospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 2.11 [0.78;5.69] -/32   1,909/24,402 - 32
ref
S7521
R22547		 Ozturk, 2016 Preterm Births (<37 weeks) at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.21 [0.07;22.37] C 0/12   8/246 8 12
ref
S7180
R20220		 Colvin, 2011 Preterm birth (<37 weeks) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.41 [1.02;1.96] 81/676   7,480/92,995 7,561 676
ref
S5928
R15106		 Calderon-Margalit, 2009 Preterm delivery (before 37 weeks of gestation) during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 2.30 [0.90;5.83] 8/31   234/2,493 242 31
ref
S5957
R15299		 Diav-Citrin, 2008 Preterm delivery (<= 36 weeks) during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.38 [0.91;2.10] C 33/381   84/1,306 117 381
ref
Total 8 studies 1.24 [1.00;1.55] 156,701 4,058
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 0.34[0.11; 1.09]28,546773%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Martin, 2024Martin, 2024 1.12[0.96; 1.30]120,1582,79439%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Marks (Controls exposed to Bupropion), 2021Marks, 2021 2 0.96[0.43; 2.14]69557%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Kivistö, 2016Kivistö, 2016 2.11[0.78; 5.69]-324%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Ozturk, 2016Ozturk, 2016 1.21[0.07; 22.37]8121%ROB confusion: criticalROB selection: unclearROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Colvin, 2011Colvin, 2011 1.41[1.02; 1.96]7,56167623%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Calderon-Margalit, 2009Calderon-Margalit, 2009 2.30[0.90; 5.83]242315%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Diav-Citrin, 2008Diav-Citrin, 2008 1.38[0.91; 2.10]11738118%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: unclearROB reporting: moderate Total (8 studies) I2 = 31% 1.24[1.00; 1.55]156,7014,0580.25.01.0ROB: 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 1.24[1.00; 1.55]156,7014,05831%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Ozturk, 2016 Colvin, 2011 Calderon-Margalit, 2009 Diav-Citrin, 2008 8 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.27[0.99; 1.63]156,6324,00339%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Ozturk, 2016 Colvin, 2011 Calderon-Margalit, 2009 Diav-Citrin, 2008 7 exposed to other treatment, sickexposed to other treatment, sick 0.96[0.43; 2.14]6955 -NAMarks (Controls exposed to Bupropion), 2021 1 Tags Adjustment   - No  - No 1.27[0.88; 1.84]1944480%NAMarks (Controls exposed to Bupropion), 2021 Ozturk, 2016 Diav-Citrin, 2008 3   - Yes  - Yes 1.26[0.89; 1.78]156,5073,61057%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Colvin, 2011 Calderon-Margalit, 2009 5 Monotherapy   - no or not specified  - no or not specified 1.50[1.02; 2.19]3674240%NAOzturk, 2016 Calderon-Margalit, 2009 Diav-Citrin, 2008 3   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.03[0.64; 1.66]148,7732,95849%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, ...) 1.41[1.02; 1.95]7,561676 -NAColvin, 2011 1 All studiesAll studies 1.24[1.00; 1.55]156,7014,05831%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Ozturk, 2016 Colvin, 2011 Calderon-Margalit, 2009 Diav-Citrin, 2008 80.15.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.53.71.7830.000Lee (Controls unexposed, general pop), 2025Martin, 2024Marks (Controls exposed to Bupropion), 2021Kivistö, 2016Ozturk, 2016Colvin, 2011Calderon-Margalit, 2009Diav-Citrin, 2008

Asymetry test p-value = 0.7359 (by Egger's regression)

slope=0.1395 (0.1225); intercept=0.2385 (0.6749); t=0.3533; p=0.7359

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) 1.27[0.99; 1.63]158,5324,00339%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Ozturk, 2016 Colvin, 2011 Calderon-Margalit, 2009 Diav-Citrin, 2008 7 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.68[0.29; 1.62]13013236%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 Xing (Preterm birth)Xing (Preterm birth) 1.54[1.11; 2.15]3%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT3 Vlenterie (Preterm birth (delivery before 37 ...Vlenterie (Preterm birth (delivery before 37 weeks of gestation)) 1.20[0.40; 4.10]-U,GPunexposed (general population or NOS)Anyduring pregnancy (anytime or not specified)studies TTT8 Vlenterie (Preterm birth (delivery before 37 ...Vlenterie (Preterm birth (delivery before 37 weeks of gestation)) 1.00[0.30; 3.70]-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT8 metaPregmetaPreg 1.24[1.00; 1.55]31%4,058----Lee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Ozturk, 2016 Colvin, 2011 Calderon-Margalit, 2009 Diav-Citrin, 2008 80.510.01.0