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

Low Apgar score (< 7) (at 1 min)

id	Study   Auto Lee (Controls exposed to TCAs), 2025Lee (Controls unexposed, general pop), 2025Lyn, 2023Hogue, 2017Bakaysa, 2016Kivistö, 2016Wisner (Controls unexposed, disease free), 2009Wisner (Controls unexposed, sick), 2009	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimesterPaternal exp. genotoxic window only (0–3 months preconception)Paternal exposure: epigenetic window only (3–xxx months preconception)Paternal exposure: genotoxic/epigenetic window (0–xxx months preconception)Paternal exposure: other window	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S18442 R78278	Lee (Controls exposed to TCAs), 2025	1-minute Apgar score <7	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: No Monotherapy: SSRI only	0.89 [0.59;1.36] C excluded (control group)	73/1,465   34/613	107	1,465		ref
S18408 R77700	Lee (Controls unexposed, general pop), 2025	1-minute Apgar score <7	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	1.41 [1.09;1.82]	73/1,465   14,883/463,440	14,956	1,465		ref
S14995 R61358	Lyn, 2023	1 min Apgar score of less than seven	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	2.11 [0.97;4.58]	-/130   -/259	-	130		ref
S7569 R22725	Hogue, 2017	1-minute Apgar score less than 7 (in full-term neonates)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	3.60 [1.06;12.50]	15/117   6/116	21	117		ref
S13007 R49379	Bakaysa, 2016	Low APGAR scores at 1 minute (< 7)	late pregnancy	retrospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	2.00 [1.10;3.50]	27/112   32/224	59	112		ref
S7570 R22764	Kivistö, 2016	Low (<7) Apgar score at 1 min	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	2.29 [1.65;3.18]	51/358   1,451/24,402	1,502	358		ref
S5408 R16601	Wisner (Controls unexposed, disease free), 2009	Apgar Score ≤7 at 1 minute	throughout pregnancy	prospective cohort	unexposed, disease free excluded	Adjustment: No Monotherapy: no or not specified	1.33 [0.53;3.32] C excluded (control group)	8/48   17/130	25	48		ref
S6249 R16609	Wisner (Controls unexposed, sick), 2009	Apgar Score ≤7 at 1 minute	throughout pregnancy	prospective cohort	unexposed, sick	Adjustment: No Monotherapy: no or not specified Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy)	0.73 [0.17;3.24] C	8/48   3/14	11	48		ref
					Total	6 studies	1.84 [1.38;2.46]		16,549	2,230
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

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded 5408, 18442

Umbrella review (other published meta-analyses)