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

Very preterm (28 to 32 weeks)

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
R47051		 Benevent, 2023 Very preterm (< 32 weeks) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: SSRI only 1.63 [1.04;2.54] C 20/1,638   1,102/146,034 1,122 1,638
ref
S18233
R76470		 Rommel, 2022 Very preterm (28–3 2 weeks) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes Monotherapy: SSRI only Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 1.05 [0.82;1.34] -/16,429   -/23,676 - 16,429
ref
S5430
R21326		 Norby, 2016 Gestational age <32 at birth during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 0.80 [0.70;1.00] -/17,736   -/718,533 - 17,736
ref
S6107
R15967		 Malm (Controls unexposed, disease free), 2015 Preterm birth <32 weeks during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: Yes Monotherapy: no or not specified 0.78 [0.57;1.07]
excluded (control group) 		80/15,729   186/31,394 266 15,729
ref
S5374
R15951		 Malm (Controls unexposed, sick), 2015 Preterm birth <32 weeks during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 0.52 [0.37;0.74] 80/15,729   93/9,652 173 15,729
ref
S5379
R17687		 Roca, 2011 Early preterm birth (< 32 weeks) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: No Matched Monotherapy: no or not specified 2.01 [0.04;101.99] C 0/84   0/168 0 84
ref
S5408
R16598		 Wisner (Controls unexposed, disease free), 2009 Early Preterm (<34 weeks) throughout pregnancy prospective cohort unexposed, disease free excluded Adjustment: No Monotherapy: no or not specified 5.65 [0.50;63.81] C
excluded (control group) 		2/48   1/131 3 48
ref
S6249
R16606		 Wisner (Controls unexposed, sick), 2009 Early Preterm (<34 weeks) 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) 0.57 [0.05;6.74] C 2/48   1/14 3 48
ref
Total 6 studies 0.90 [0.64;1.25] 1,298 51,664
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 1.63[1.04; 2.54]1,1221,63820%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Rommel, 2022Rommel, 2022 1.05[0.82; 1.34]-16,42926%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Norby, 2016Norby, 2016 0.80[0.70; 1.00]-17,73628%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Malm (Controls unexposed, sick), 2015Malm, 2015 1 0.52[0.37; 0.74]17315,72923%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: moderateROB mesure: moderateROB reporting: moderate Roca, 2011Roca, 2011 2.01[0.04; 101.99]0841%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Wisner (Controls unexposed, sick), 2009Wisner, 2009 2 0.57[0.05; 6.74]3482%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Total (6 studies) I2 = 74% 0.90[0.64; 1.25]1,29851,6640.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

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

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.90[0.64; 1.25]1,29851,66474%NABenevent, 2023 Rommel, 2022 Norby, 2016 Malm (Controls unexposed, sick), 2015 Roca, 2011 Wisner (Controls unexposed, sick), 2009 6 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.12[0.59; 2.13]1,12219,45877%NABenevent, 2023 Norby, 2016 Roca, 2011 3 unexposed, sickunexposed, sick 0.74[0.39; 1.39]17632,20681%NARommel, 2022 Malm (Controls unexposed, sick), 2015 Wisner (Controls unexposed, sick), 2009 3 Tags Adjustment   - No  - No 1.07[0.60; 1.92]1,12519,50666%NABenevent, 2023 Norby, 2016 Roca, 2011 Wisner (Controls unexposed, sick), 2009 4   - Yes  - Yes 0.75[0.38; 1.49]17332,15890%NARommel, 2022 Malm (Controls unexposed, sick), 2015 2 MatchedMatched 2.01[0.04; 101.99]-84 -NARoca, 2011 1 Monotherapy   - no or not specified  - no or not specified 0.68[0.49; 0.93]17633,59740%NANorby, 2016 Malm (Controls unexposed, sick), 2015 Roca, 2011 Wisner (Controls unexposed, sick), 2009 4   - SSRI only  - SSRI only 1.25[0.82; 1.91]1,12218,06765%NABenevent, 2023 Rommel, 2022 2 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 0.75[0.38; 1.49]17332,15890%NARommel, 2022 Malm (Controls unexposed, sick), 2015 2   - recent illness/treatment (during o ...  - recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 0.57[0.05; 6.74]348 -NAWisner (Controls unexposed, sick), 2009 1 All studiesAll studies 0.90[0.64; 1.25]1,29851,66474%NABenevent, 2023 Rommel, 2022 Norby, 2016 Malm (Controls unexposed, sick), 2015 Roca, 2011 Wisner (Controls unexposed, sick), 2009 60.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.74.62.4050.000Benevent, 2023Rommel, 2022Norby, 2016Malm (Controls unexposed, sick), 2015Roca, 2011Wisner (Controls unexposed, sick), 2009

Asymetry test p-value = 0.8083 (by Egger's regression)

slope=-0.1998 (0.2391); intercept=0.3892 (1.5021); t=0.2591; p=0.8083

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 5408, 6107

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.00[0.70; 1.45]1,39135,23565%NABenevent, 2023 Norby, 2016 Malm (Controls unexposed, disease free), 2015 Roca, 2011 Wisner (Controls unexposed, disease free), 2009 5 unexposed, sick controlsunexposed, sick controls 0.74[0.39; 1.39]17632,20681%NARommel, 2022 Malm (Controls unexposed, sick), 2015 Wisner (Controls unexposed, sick), 2009 30.510.01.0