Selective Serotonin Reuptake Inhibitor (SSRI) updated on 07-01-2025

Assisted deliveries (forceps, vacuum, ...)

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.
S18442
R78267		 Lee (Controls exposed to TCAs), 2025 Instrumental delivery during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: SSRI only 1.05 [0.75;1.48] C
excluded (control group) 		125/1,465   50/613 175 1,465
ref
S18408
R77689		 Lee (Controls unexposed, general pop), 2025 Instrumental delivery during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 1.07 [0.95;1.20] 125/1,465   46,036/463,440 46,161 1,465
ref
S18131
R76219		 Raviv, 2025 Vaginal assisted delivery during pregnancy (anytime or not specified) retrospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.95 [1.73;2.22] C 292/2,321   7,104/103,607 7,396 2,321
ref
S7570
R22769		 Kivistö, 2016 Vacuum assistance during pregnancy (anytime or not specified) retrospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 1.00 [0.65;1.55] 23/358   1,609/24,402 1,632 358
ref
S5379
R17685		 Roca, 2011 Assisted delivery (vacuum or forceps) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: No Matched Monotherapy: no or not specified 1.00 [0.51;1.95] C 16/84   32/168 48 84
ref
S6197
R16360		 Pastuszak - Fluoxetine (Controls exposed to TCA), 1993 Forceps used 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No Matched Monotherapy: SSRI only 1.26 [0.32;5.03] C
excluded (control group) 		4/23   6/42 10 23
ref
S515
R19619		 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 Forceps used 1st trimester excluded prospective cohort unexposed (general population or NOS) Adjustment: No Matched Monotherapy: SSRI only 2.19 [0.77;6.22] C
excluded (exposition period) 		8/38   9/83 17 38
ref
Total 4 studies 1.24 [0.81;1.91] 55,237 4,228
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 1.07[0.95; 1.20]46,1611,46530%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Raviv, 2025Raviv, 2025 1.95[1.73; 2.22]7,3962,32130%ROB confusion: criticalROB selection: unclearROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Kivistö, 2016Kivistö, 2016 1.00[0.65; 1.55]1,63235823%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Roca, 2011Roca, 2011 1.00[0.51; 1.95]488418%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 94% 1.24[0.81; 1.91]55,2374,2280.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, general pop;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.24[0.81; 1.91]55,2374,22894%NALee (Controls unexposed, general pop), 2025 Raviv, 2025 Kivistö, 2016 Roca, 2011 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.24[0.81; 1.91]55,2374,22894%NALee (Controls unexposed, general pop), 2025 Raviv, 2025 Kivistö, 2016 Roca, 2011 4 Tags Adjustment   - No  - No 1.52[0.80; 2.87]7,4442,40573%NARaviv, 2025 Roca, 2011 2   - Yes  - Yes 1.07[0.95; 1.19]47,7931,8230%NALee (Controls unexposed, general pop), 2025 Kivistö, 2016 2 MatchedMatched 1.00[0.51; 1.95]4884 -NARoca, 2011 1 Monotherapy   - no or not specified  - no or not specified 1.52[0.80; 2.87]7,4442,40573%NARaviv, 2025 Roca, 2011 2   - SSRI only  - SSRI only 1.07[0.95; 1.19]47,7931,8230%NALee (Controls unexposed, general pop), 2025 Kivistö, 2016 2 All studiesAll studies 1.24[0.81; 1.91]55,2374,22894%NALee (Controls unexposed, general pop), 2025 Raviv, 2025 Kivistö, 2016 Roca, 2011 40.55.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-0.81.00.4080.000Lee (Controls unexposed, general pop), 2025Raviv, 2025Kivistö, 2016Roca, 2011

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 6197, 18442

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.24[0.81; 1.91]55,2374,22894%NALee (Controls unexposed, general pop), 2025 Raviv, 2025 Kivistö, 2016 Roca, 2011 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.05[0.75; 1.48]1751,465 -NALee (Controls exposed to TCAs), 2025 10.510.01.0