Fluoxetine updated on 07-01-2025

Assisted deliveries (forceps, vacuum, ...)

id	Study   Auto Lee (Controls exposed to TCAs), 2025Lee (Controls unexposed, general pop), 2025Kivistö, 2016Pastuszak (Controls exposed to TCA), 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.
S18436 R78141	Lee (Controls exposed to TCAs), 2025	Instrumental delivery	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	1.01 [0.68;1.49] C excluded (control group)	59/719   50/613	109	719		ref
S18415 R77836	Lee (Controls unexposed, general pop), 2025	Instrumental delivery	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	0.97 [0.74;1.28]	59/719   46,036/463,440	46,095	719		ref
S7693 R22801	Kivistö, 2016	Vacuum assistance	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	1.32 [0.46;3.79]	-/51   1,609/24,402	-	51		ref
S6202 R16367	Pastuszak (Controls exposed to TCA), 1993	Forceps used	1st trimester	prospective cohort	exposed to other treatment, sick excluded	Adjustment: No Matched Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	1.26 [0.32;5.03] C excluded (control group)	4/23   6/42	10	23		ref
S6952 R19659	Pastuszak (Controls unexposed, NOS), 1993	Forceps used	1st trimester excluded	prospective cohort	unexposed (general population or NOS)	Adjustment: No Matched Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	2.19 [0.77;6.22] C excluded (exposition period)	8/38   9/83	17	38		ref
					Total	2 studies	0.99 [0.76;1.29]		46,095	770
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 6202, 18436