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

Child/Infant death (> 28 days of life)

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
R78283		 Lee (Controls exposed to TCAs), 2025 Infant death (29–365 days after birth) during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: SSRI only 0.42 [0.01;21.10] C
excluded (control group) 		0/1,465   0/613 0 1,465
ref
S18408
R77705		 Lee (Controls unexposed, general pop), 2025 Infant death (29–365 days after birth) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: SSRI only 1.21 [0.08;19.49] C 0/1,465   130/463,440 130 1,465
ref
S7572
R23847		 Stephansson, 2013 Postneonatal death (death between 28-364 days among neonatal survivors) throughout pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.76 [0.79;3.93] 6/-   1,538/1,604,649 1,544 -
ref
S5428
R20518		 Colvin, 2012 Death before 1 year during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.38 [1.06;1.81] 58/3,764   1,058/94,561 1,116 3,764
ref
S15011
R61500		 Lennestal, 2007 All Deaths <1 yr of Age late pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.20 [0.70;2.00] 12/-   5,084/- 5,096 -
ref
S5405
R16050		 Wen, 2006 Infant death (< 1 year) 3 months (or more) before pregnancy or during pregnancy excluded retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Matched Monotherapy: no or not specified 1.96 [0.97;3.94]
excluded (exposition period) 		15/972   22/3,878 37 972
ref
Total 4 studies 1.37 [1.09;1.72] 7,886 5,229
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 1.21[0.08; 19.49]1301,4651%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Stephansson, 2013Stephansson, 2013 1.76[0.79; 3.93]1,544-8%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Colvin, 2012Colvin, 2012 1.38[1.06; 1.81]1,1163,76472%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Lennestal, 2007Lennestal, 2007 1.20[0.70; 2.00]5,096-19%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 1.37[1.09; 1.72]7,8865,2290.55.01.0ROB: 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 1.37[1.09; 1.72]7,8865,2290%NALee (Controls unexposed, general pop), 2025 Stephansson, 2013 Colvin, 2012 Lennestal, 2007 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.37[1.09; 1.72]7,8865,2290%NALee (Controls unexposed, general pop), 2025 Stephansson, 2013 Colvin, 2012 Lennestal, 2007 4 Tags Adjustment   - No  - No 1.38[1.06; 1.80]1,2465,2290%NALee (Controls unexposed, general pop), 2025 Colvin, 2012 2   - Yes  - Yes 1.35[0.87; 2.09]6,640-0%NAStephansson, 2013 Lennestal, 2007 2 Monotherapy   - no or not specified  - no or not specified 1.37[1.09; 1.72]7,7563,7640%NAStephansson, 2013 Colvin, 2012 Lennestal, 2007 3   - SSRI only  - SSRI only 1.21[0.08; 19.49]1301,465 -NALee (Controls unexposed, general pop), 2025 1 All studiesAll studies 1.37[1.09; 1.72]7,8865,2290%NALee (Controls unexposed, general pop), 2025 Stephansson, 2013 Colvin, 2012 Lennestal, 2007 40.55.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.33.61.7010.000Lee (Controls unexposed, general pop), 2025Stephansson, 2013Colvin, 2012Lennestal, 2007

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 18442

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.37[1.09; 1.72]7,8865,2290%NALee (Controls unexposed, general pop), 2025 Stephansson, 2013 Colvin, 2012 Lennestal, 2007 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls Out of scale0.42[0.01; 21.10]-1,465 -NALee (Controls exposed to TCAs), 2025 10.510.01.0