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

Therapeutic terminations of pregnancy

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.
S9999
R36007		 Kieler, 2015 Termination of pregnancy for Fetal anomaly during pregnancy (anytime or not specified) nested case control unexposed (general population or NOS) Adjustment: Yes Matched Monotherapy: SSRI only 1.00 [0.80;1.20] -/-   0/- - -
ref
S5395
R16285		 Klieger-Grossmann - Escitalopram, 2012 Therapeutic abortion during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: No Matched Monotherapy: SSRI only 6.12 [0.73;51.24] C 6/213   1/212 7 213
ref
S507
R16621		 Vial - Paroxetine, 2006 Medical abortion 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Matched Monotherapy: no or not specified 2.63 [0.93;7.42] C 13/683   5/683 18 683
ref
S508
R17588		 Sivojelezova - Citalopram, 2005 Therapeutic abortions during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: No Matched Monotherapy: no or not specified 5.08 [0.24;106.79] C 2/132   0/132 2 132
ref
S512
R15344		 Einarson, 2001 Therapeutic abortions 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 5.29 [1.14;24.55] C 10/150   2/150 12 150
ref
S513
R377		 Kulin, 1998 Therapeutic abortions 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.71 [0.73;3.97] C 15/267   9/267 24 267
ref
S490
R15190		 Chambers - Fluoxetine, 1996 Therapeutic abortion 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 5.88 [2.45;14.13] C 22/154   7/254 29 154
ref
Total 7 studies 2.70 [1.27;5.74] 92 1,599
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 Kieler, 2015Kieler, 2015 1.00[0.80; 1.20]--23%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Klieger-Grossmann - Escitalopram, 2012Klieger-Grossmann - Escitalopram, 2012 6.12[0.73; 51.24]72138%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Vial - Paroxetine, 2006Vial - Paroxetine, 2006 2.63[0.93; 7.42]1868316%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: unclearROB reporting: unclear Sivojelezova - Citalopram, 2005Sivojelezova - Citalopram, 2005 5.08[0.24; 106.79]21325%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Einarson, 2001Einarson, 2001 5.29[1.14; 24.55]1215012%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Kulin, 1998Kulin, 1998 1.71[0.73; 3.97]2426718%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Chambers - Fluoxetine, 1996Chambers - Fluoxetine, 1996 5.88[2.45; 14.13]2915418%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Total (7 studies) I2 = 76% 2.70[1.27; 5.74]921,5990.520.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 3.30[2.05; 5.32]921,5990%NAKlieger-Grossmann - Escitalopram, 2012 Vial - Paroxetine, 2006 Sivojelezova - Citalopram, 2005 Einarson, 2001 Kulin, 1998 Chambers - Fluoxetine, 1996 6 case control studiescase control studies 1.00[0.82; 1.22]-- -NAKieler, 2015 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.70[1.27; 5.74]921,59976%NAKieler, 2015 Klieger-Grossmann - Escitalopram, 2012 Vial - Paroxetine, 2006 Sivojelezova - Citalopram, 2005 Einarson, 2001 Kulin, 1998 Chambers - Fluoxetine, 1996 7 Tags Adjustment   - No  - No 3.30[2.05; 5.32]921,5990%NAKlieger-Grossmann - Escitalopram, 2012 Vial - Paroxetine, 2006 Sivojelezova - Citalopram, 2005 Einarson, 2001 Kulin, 1998 Chambers - Fluoxetine, 1996 6   - Yes  - Yes 1.00[0.82; 1.22]-- -NAKieler, 2015 1 MatchedMatched 1.92[0.78; 4.73]271,02857%NAKieler, 2015 Klieger-Grossmann - Escitalopram, 2012 Vial - Paroxetine, 2006 Sivojelezova - Citalopram, 2005 4 Monotherapy   - no or not specified  - no or not specified 3.23[1.88; 5.56]851,38613%NAVial - Paroxetine, 2006 Sivojelezova - Citalopram, 2005 Einarson, 2001 Kulin, 1998 Chambers - Fluoxetine, 1996 5   - SSRI only  - SSRI only 1.79[0.34; 9.42]721364%NAKieler, 2015 Klieger-Grossmann - Escitalopram, 2012 2 All studiesAll studies 2.70[1.27; 5.74]921,59976%NAKieler, 2015 Klieger-Grossmann - Escitalopram, 2012 Vial - Paroxetine, 2006 Sivojelezova - Citalopram, 2005 Einarson, 2001 Kulin, 1998 Chambers - Fluoxetine, 1996 70.520.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.74.61.8650.000Kieler, 2015Klieger-Grossmann - Escitalopram, 2012Vial - Paroxetine, 2006Sivojelezova - Citalopram, 2005Einarson, 2001Kulin, 1998Chambers - Fluoxetine, 1996

Asymetry test p-value = 0.0120 (by Egger's regression)

slope=-0.2039 (0.1472); intercept=2.2482 (0.5845); t=3.8465; p=0.0120

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) 2.70[1.27; 5.74]921,59976%NAKieler, 2015 Klieger-Grossmann - Escitalopram, 2012 Vial - Paroxetine, 2006 Sivojelezova - Citalopram, 2005 Einarson, 2001 Kulin, 1998 Chambers - Fluoxetine, 1996 70.510.01.0