Serotonin and Noradrenaline Reuptake Inhibitors (SNRI) updated on 07-01-2025

Low birth weight (< 2500g)

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.
S18440
R78233
Lee (Controls exposed to TCAs), 2025 Low birth weight (birth weight <2500 g) during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: SNRI only 1.47 [0.74;2.93] C
excluded (control group)
11/71   68/613 79 71
ref
S18441
R78254
Lee (Controls unexposed, general pop), 2025 Low birth weight (birth weight <2500 g) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: SNRI only 1.41 [0.74;2.70] 11/71   31,347/463,440 31,358 71
ref
S15171
R62276
Benevent - SNRI, 2023 Low birth weight during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: SNRI only 1.40 [0.84;2.34] C 16/215   7,763/143,301 7,779 215
ref
S11693
R42996
Reis - SNRI (Controls exposed to TCA), 2010 Low birthweight (<2500 g) 2nd and/or 3rd trimester population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No Monotherapy: SNRI only 1.45 [0.90;2.32] C
excluded (control group)
36/538   37/784 73 538
ref
S11694
R43008
Reis - SNRI (Controls unexposed, NOS), 2010 Low birthweight (<2500 g) 2nd and/or 3rd trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: SNRI only 1.87 [1.33;2.64] 36/538   37,105/1,062,190 37,141 538
ref
S13352
R51469
Calderon-Margalit - Venlafaxine, 2009 Low Birth-Weight (< 2500gr) during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 2.14 [0.35;13.30] -/9   -/2,493 - 9
ref
Total 4 studies 1.67 [1.29;2.16] 76,278 833
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 1.41[0.74; 2.70]31,3587116%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Benevent - SNRI, 2023Benevent - SNRI, 2023 1.40[0.84; 2.34]7,77921526%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Reis - SNRI (Controls unexposed, NOS), 2010Reis - SNRI, 2010 2 1.87[1.33; 2.64]37,14153857%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Calderon-Margalit - Venlafaxine, 2009Calderon-Margalit - Venlafaxine, 2009 2.14[0.35; 13.30]-92%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 1.67[1.29; 2.16]76,2788330.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, general pop; 2: Controls unexposed, NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.67[1.29; 2.16]76,2788330%NALee (Controls unexposed, general pop), 2025 Benevent - SNRI, 2023 Reis - SNRI (Controls unexposed, NOS), 2010 Calderon-Margalit - Venlafaxine, 2009 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.67[1.29; 2.16]76,2788330%NALee (Controls unexposed, general pop), 2025 Benevent - SNRI, 2023 Reis - SNRI (Controls unexposed, NOS), 2010 Calderon-Margalit - Venlafaxine, 2009 4 Tags Adjustment   - No  - No 1.40[0.84; 2.34]7,779215 -NABenevent - SNRI, 2023 1   - Yes  - Yes 1.77[1.31; 2.38]68,4996180%NALee (Controls unexposed, general pop), 2025 Reis - SNRI (Controls unexposed, NOS), 2010 Calderon-Margalit - Venlafaxine, 2009 3 Monotherapy   - no or not specified  - no or not specified 2.14[0.35; 13.19]-9 -NACalderon-Margalit - Venlafaxine, 2009 1   - SNRI only  - SNRI only 1.66[1.28; 2.15]76,2788240%NALee (Controls unexposed, general pop), 2025 Benevent - SNRI, 2023 Reis - SNRI (Controls unexposed, NOS), 2010 3 All studiesAll studies 1.67[1.29; 2.16]76,2788330%NALee (Controls unexposed, general pop), 2025 Benevent - SNRI, 2023 Reis - SNRI (Controls unexposed, NOS), 2010 Calderon-Margalit - Venlafaxine, 2009 40.55.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.22.71.1140.000Lee (Controls unexposed, general pop), 2025Benevent - SNRI, 2023Reis - SNRI (Controls unexposed, NOS), 2010Calderon-Margalit - Venlafaxine, 2009

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 11693, 18440

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.67[1.29; 2.16]76,2788330%NALee (Controls unexposed, general pop), 2025 Benevent - SNRI, 2023 Reis - SNRI (Controls unexposed, NOS), 2010 Calderon-Margalit - Venlafaxine, 2009 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.45[0.98; 2.15]1526090%NALee (Controls exposed to TCAs), 2025 Reis - SNRI (Controls exposed to TCA), 2010 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Xing (Low birth weight)Xing (Low birth weight) 1.46[0.89; 2.42]72%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT2 metaPregmetaPreg 1.67[1.29; 2.16]0%833----Lee (Controls unexposed, general pop), 2025 Benevent - SNRI, 2023 Reis - SNRI (Controls unexposed, NOS), 2010 Calderon-Margalit - Venlafaxine, 2009 40.510.01.0