Tricyclic antidepressants updated on 07-01-2025

Elective/induced termination of pregnancy

id	Study   Auto Ozturk - Amitriptyline, 2016Kieler, 2015Ban (Controls exposed to SSRIs), 2012Ban (Controls unexposed, disease free), 2012Ban (Controls unexposed, sick), 2012Pastuszak (Controls exposed to Fluoxetine), 1993Pastuszak (Controls unexposed, NOS), 1993	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimesterPaternal exp. genotoxic window only (0–3 months preconception)Paternal exposure: epigenetic window only (3–xxx months preconception)Paternal exposure: genotoxic/epigenetic window (0–xxx months preconception)Paternal exposure: other window	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S11594 R42481	Ozturk - Amitriptyline, 2016	Elective termination of pregnancy	at least 1st trimester	prospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	2.57 [0.13;52.07] C	0/4   14/275	14	4		ref
S11013 R40921	Kieler, 2015	Elective termination of pregnancy (at 12–23 weeks of gestation)	during pregnancy (anytime or not specified)	nested case control	unexposed (general population or NOS)	Adjustment: Yes Matched Monotherapy: TCA only	1.30 [0.80;1.90]	-/-   14,911/-	-	-		ref
S11223 R41299	Ban (Controls exposed to SSRIs), 2012	Termination of pregnancy	during pregnancy (anytime or not specified)	population based cohort retrospective	exposed to other treatment, sick excluded	Adjustment: No Monotherapy: TCA only	0.70 [0.64;0.76] C excluded (control group)	708/4,349   3,090/14,191	3,798	4,349		ref
S11221 R41293	Ban (Controls unexposed, disease free), 2012	Termination of pregnancy	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, disease free excluded	Adjustment: Yes Monotherapy: TCA only	1.70 [1.50;1.90] excluded (control group)	708/4,349   -/-	-	4,349		ref
S11222 R41296	Ban (Controls unexposed, sick), 2012	Termination of pregnancy	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, sick	Adjustment: Yes Monotherapy: TCA only Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy)	1.40 [1.20;1.70]	708/4,349   -/-	-	4,349		ref
S10931 R40649	Pastuszak (Controls exposed to Fluoxetine), 1993	Elective abortions	1st trimester	prospective cohort	exposed to other treatment, sick excluded	Adjustment: No Matched Monotherapy: TCA only	0.82 [0.24;2.82] C excluded (control group)	5/74   6/74	11	74		ref
S10932 R40660	Pastuszak (Controls unexposed, NOS), 1993	Elective abortions	1st trimester	prospective cohort	unexposed (general population or NOS)	Adjustment: No Matched Monotherapy: TCA only	2.61 [0.49;13.90] C	5/74   2/74	7	74		ref
					Total	4 studies	1.40 [1.19;1.64]		21	4,427
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

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded 10931, 11223, 11221