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

Ano-rectal atresia and stenosis

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.
S7467
R22127		 Anderson, 2020 Anorectal atresia/stenosis 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 0.97 [0.66;1.44] -/-   0/- - -
ref
S516
R15356		 Furu (Controls unexposed, NOS), 2015 Anal atresia 1st trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 1.43 [0.88;2.32] 19/36,772   780/2,266,875 799 36,772
ref
S7348
R21408		 Wemakor, 2015 Ano-rectal atresia and stenosis 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 2.46 [1.06;5.68] 6/105   386/17,370 392 105
ref
S495
R76915		 Källén, 2007 Anal atresia early pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 0.56 [0.07;2.04] 2/6,555   495/873,876 497 6,555
ref
S5424
R16110		 Louik, 2007 Anal atresia 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.90 [0.80;4.30] 7/167   208/5,908 215 167
ref
Total 5 studies 1.35 [0.93;1.96] 1,903 43,599
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 Anderson, 2020Anderson, 2020 0.97[0.66; 1.44]--36%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Furu (Controls unexposed, NOS), 2015Furu, 2015 1 1.43[0.88; 2.32]79936,77230%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Wemakor, 2015Wemakor, 2015 2.46[1.06; 5.68]39210515%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Källén, 2007Källén, 2007 0.56[0.07; 2.04]4976,5555%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Louik, 2007Louik, 2007 1.90[0.80; 4.30]21516715%ROB confusion: moderateROB selection: criticalROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Total (5 studies) I2 = 36% 1.35[0.93; 1.96]1,90343,5990.25.01.0ROB: 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 1.29[0.72; 2.30]1,29643,3279%NAFuru (Controls unexposed, NOS), 2015 Källén, 2007 2 case control studiescase control studies 1.51[0.81; 2.80]60727261%NAAnderson, 2020 Wemakor, 2015 Louik, 2007 3 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.35[0.93; 1.96]1,90343,59936%NAAnderson, 2020 Furu (Controls unexposed, NOS), 2015 Wemakor, 2015 Källén, 2007 Louik, 2007 5 Tags Adjustment   - Yes  - Yes 1.35[0.93; 1.96]1,90343,59936%NAAnderson, 2020 Furu (Controls unexposed, NOS), 2015 Wemakor, 2015 Källén, 2007 Louik, 2007 5 Monotherapy   - no or not specified  - no or not specified 1.90[0.82; 4.40]215167 -NALouik, 2007 1   - SSRI only  - SSRI only 1.28[0.83; 1.96]1,68843,43243%NAAnderson, 2020 Furu (Controls unexposed, NOS), 2015 Wemakor, 2015 Källén, 2007 4 All studiesAll studies 1.35[0.93; 1.96]1,90343,59936%NAAnderson, 2020 Furu (Controls unexposed, NOS), 2015 Wemakor, 2015 Källén, 2007 Louik, 2007 50.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.02.31.0320.000Anderson, 2020Furu (Controls unexposed, NOS), 2015Wemakor, 2015Källén, 2007Louik, 2007

Asymetry test p-value = 0.6220 (by Egger's regression)

slope=0.0134 (0.4470); intercept=0.8035 (1.4669); t=0.5478; p=0.6220

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.35[0.93; 1.96]1,90343,59936%NAAnderson, 2020 Furu (Controls unexposed, NOS), 2015 Wemakor, 2015 Källén, 2007 Louik, 2007 50.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Zwink - SSRI (Anorectal malformations)Zwink - SSRI (Anorectal malformations) 1.48[0.94; 2.30]34%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT4 metaPregmetaPreg 1.35[0.93; 1.96]36%43,599----Anderson, 2020 Furu (Controls unexposed, NOS), 2015 Wemakor, 2015 Källén, 2007 Louik, 2007 50.510.01.0