Sertraline updated on 07-01-2025

Withdrawal syndrome / Neonatal abstinence syndrome / Poor neonatal adaptation

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.
S12953
R49161		 Heinonen, 2021 Neonatal Abstinence Scale (NAS) (mild, moderate, severe) 3rd trimester randomized controlled trial unexposed, sick Adjustment: Randomisation Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.40 [0.02;10.02] C 2/7   1/2 3 7
ref
S13130
R50067		 Marks (Controls exposed to Bupropion), 2021 Any adaptation syndrome (Neonatal abstinence syndrome (NAS) or Pediatric adaptation syndromes (PAS)) during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick excluded Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.96 [0.57;1.63]
excluded (control group) 		75/1,653   19/406 94 1,653
ref
S13131
R50078		 Marks (Controls unexposed, sick), 2021 Any adaptation syndrome (Neonatal abstinence syndrome (NAS) or Pediatric adaptation syndromes (PAS)) 3rd trimester retrospective cohort unexposed, sick Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 1.56 [1.09;2.24] -/883   -/- - 883
ref
S8157
R25124		 Dave, 2019 Neonatal abstinence syndrome 3rd trimester nested case control unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 8.09 [5.63;11.62] C 31/3,800   628/618,140 659 3,800
ref
S6195
R16329		 Levinson-Castiel, 2006 Severe neonatal abstinence syndrome (Finnegan score of 8 or higher) 3rd trimester retrospective cohort unexposed, disease free Adjustment: No Monotherapy: no or not specified 119.00 [0.97;14571.79] C 0/1   0/60 0 1
ref
Total 4 studies 3.43 [0.81;14.60] 662 4,691
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 Heinonen, 2021Heinonen, 2021 0.40[0.02; 10.02]3713%ROB confusion: unclearROB selection: lowROB classification: lowROB missing: criticalROB mesure: lowROB reporting: low Marks (Controls unexposed, sick), 2021Marks, 2021 1 1.56[1.09; 2.24]-88340%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Dave, 2019Dave, 2019 8.09[5.63; 11.62]6593,80040%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Levinson-Castiel, 2006Levinson-Castiel, 2006 119.00[0.97; 14571.79]017%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (4 studies) I2 = 93% 3.43[0.81; 14.60]6624,6910.2500.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 6.83[0.12; 383.11]-88468%NAMarks (Controls unexposed, sick), 2021 Levinson-Castiel, 2006 2 case control studiescase control studies 8.09[5.63; 11.62]6593,800 -NADave, 2019 1 RCTRCT 0.40[0.02; 10.02]37 -NAHeinonen, 2021 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 10.20[2.32; 44.77]6593,80116%NADave, 2019 Levinson-Castiel, 2006 2 unexposed, sickunexposed, sick 1.53[1.07; 2.19]38900%NAHeinonen, 2021 Marks (Controls unexposed, sick), 2021 2 Tags Adjustment   - No  - No 10.20[2.32; 44.77]6593,80116%NADave, 2019 Levinson-Castiel, 2006 2   - Randomisation  - Randomisation 0.40[0.02; 10.02]37 -NAHeinonen, 2021 1   - Yes  - Yes 1.56[1.09; 2.24]-883 -NAMarks (Controls unexposed, sick), 2021 1 Monotherapy   - no or not specified  - no or not specified 10.20[2.32; 44.77]6593,80116%NADave, 2019 Levinson-Castiel, 2006 2   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.53[1.07; 2.19]38900%NAHeinonen, 2021 Marks (Controls unexposed, sick), 2021 2 Unexposed sick   - recent illness/treatment (during o ...  - recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 1.56[1.09; 2.24]-883 -NAMarks (Controls unexposed, sick), 2021 1 All studiesAll studies 3.43[0.81; 14.60]6624,69193%NAHeinonen, 2021 Marks (Controls unexposed, sick), 2021 Dave, 2019 Levinson-Castiel, 2006 40.11000.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-5.87.02.9440.000Heinonen, 2021Marks (Controls unexposed, sick), 2021Dave, 2019Levinson-Castiel, 2006

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 13130

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) Out of scale10.20[2.32; 44.77]6593,80116%NADave, 2019 Levinson-Castiel, 2006 2 unexposed, sick controlsunexposed, sick controls 1.53[1.07; 2.19]38900%NAHeinonen, 2021 Marks (Controls unexposed, sick), 2021 2 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.96[0.57; 1.62]941,653 -NAMarks (Controls exposed to Bupropion), 2021 10.510.01.0