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

Chromosomal abnormalities

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.
S12482
R47067		 Benevent, 2023 Chromosomal abnormalities 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: SSRI only 1.17 [0.37;3.66] C 3/1,653   228/146,855 231 1,653
ref
S5881
R14673		 Ban (Controls exposed to TCA), 2014 Chromosomal malformations 1st trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: SSRI only 0.79 [0.25;2.52] C
excluded (control group) 		10/7,683   4/2,428 14 7,683
ref
S517
R14651		 Ban (Controls unexposed, disease free), 2014 Chromosomal malformations 1st trimester retrospective cohort (claims database) unexposed, disease free excluded Adjustment: Yes Monotherapy: SSRI only 0.79 [0.42;1.48]
excluded (control group) 		10/7,683   551/325,294 561 7,683
ref
S6700
R18878		 Ban (Controls unexposed, sick), 2014 Chromosomal malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: No Monotherapy: SSRI only Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 0.65 [0.31;1.34] C 10/7,683   27/13,432 37 7,683
ref
S6013
R15478		 Jimenez-Solem (Controls unexposed, NOS), 2012 Chromosomal abnormalities 1st trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.57 [0.74;3.31] 7/4,183   -/843,797 - 4,183
ref
S493
R15247		 Colvin, 2011 Chromosome defects 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.13 [0.53;2.41] 7/2,701   216/94,561 223 2,701
ref
S5394
R20656		 Davis, 2007 Chromosomal anomalies 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 0.33 [0.02;5.30] C 0/805   92/49,031 92 805
ref
Total 5 studies 1.03 [0.69;1.53] 583 17,025
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 Benevent, 2023Benevent, 2023 1.17[0.37; 3.66]2311,65312%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Ban (Controls unexposed, sick), 2014Ban, 2014 1 0.65[0.31; 1.34]377,68330%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Jimenez-Solem (Controls unexposed, NOS), 2012Jimenez-Solem, 2012 2 1.57[0.74; 3.31]-4,18328%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: critical Colvin, 2011Colvin, 2011 1.13[0.53; 2.41]2232,70128%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Davis, 2007Davis, 2007 0.33[0.02; 5.30]928052%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 0% 1.03[0.69; 1.53]58317,0250.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Controls unexposed, NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.03[0.69; 1.53]58317,0250%NABenevent, 2023 Ban (Controls unexposed, sick), 2014 Jimenez-Solem (Controls unexposed, NOS), 2012 Colvin, 2011 Davis, 2007 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.25[0.78; 2.01]5469,3420%NABenevent, 2023 Jimenez-Solem (Controls unexposed, NOS), 2012 Colvin, 2011 Davis, 2007 4 unexposed, sickunexposed, sick 0.65[0.31; 1.34]377,683 -NABan (Controls unexposed, sick), 2014 1 Tags Adjustment   - No  - No 0.87[0.54; 1.39]58312,8420%NABenevent, 2023 Ban (Controls unexposed, sick), 2014 Colvin, 2011 Davis, 2007 4   - Yes  - Yes 1.57[0.74; 3.32]-4,183 -NAJimenez-Solem (Controls unexposed, NOS), 2012 1 Monotherapy   - no or not specified  - no or not specified 1.27[0.75; 2.14]3157,6890%NAJimenez-Solem (Controls unexposed, NOS), 2012 Colvin, 2011 Davis, 2007 3   - SSRI only  - SSRI only 0.77[0.42; 1.42]2689,3360%NABenevent, 2023 Ban (Controls unexposed, sick), 2014 2 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 0.65[0.31; 1.34]377,683 -NABan (Controls unexposed, sick), 2014 1 All studiesAll studies 1.03[0.69; 1.53]58317,0250%NABenevent, 2023 Ban (Controls unexposed, sick), 2014 Jimenez-Solem (Controls unexposed, NOS), 2012 Colvin, 2011 Davis, 2007 50.15.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.33.41.7020.000Benevent, 2023Ban (Controls unexposed, sick), 2014Jimenez-Solem (Controls unexposed, NOS), 2012Colvin, 2011Davis, 2007

Asymetry test p-value = 0.6009 (by Egger's regression)

slope=0.3542 (0.5998); intercept=-0.7705 (1.3219); t=0.5829; p=0.6009

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 5881, 517

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.06[0.72; 1.55]1,10717,0250%NABenevent, 2023 Ban (Controls unexposed, disease free), 2014 Jimenez-Solem (Controls unexposed, NOS), 2012 Colvin, 2011 Davis, 2007 5 unexposed, sick controlsunexposed, sick controls 0.65[0.31; 1.34]377,683 -NABan (Controls unexposed, sick), 2014 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.79[0.25; 2.52]147,683 -NABan (Controls exposed to TCA), 2014 10.510.01.0