Paroxetine updated on 07-01-2025

ASD (Autism spectrum disorder): Diagnosis

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.
S18382
R77477
Heuvelman, 2023 Autism spectrum disorder - Validated Read code list among primary care clinical and referral records - Mean age at end of follow-up 10.04 years, range 4–22 years during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 2.04 [1.31;3.16] -/982   -/16,330 - 982
ref
S10009
R35968
Ames, 2021 Autism spectrum disorder (ASD): diagnostic criteria on the Autism Diagnostic Observation Schedule and the full ASD diagnostic criteria on the ADI-R or one of three alternative criteria on the ADI-R (age NOS). 3 months (or more) before pregnancy or during pregnancy excluded case control unexposed, disease free Adjustment: No Monotherapy: no or not specified 2.77 [1.20;6.40] C
excluded (exposition period)
18/26   1,349/3,012 1,367 26
ref
S6548
R18029
Brown, 2017 Autism spectrum disorder (ASD) Diagnostic (ICD-9/OHIP: 299; ICD-10: F84) - Age: 4-10 years (mean: 4.95 years) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 0.72 [0.22;2.38] -/-   -/- - -
ref
S11336
R41742
Rai (Controls exposed to TCA), 2017 Autism spectrum disorder (ICD-9 (299), ICD-10 (F84), or DSM-IV (299) codes) - At 4-17 years during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No Monotherapy: no or not specified 0.26 [0.10;0.73] C
excluded (control group)
5/264   16/235 21 264
ref
S7483
R22400
Rai (Controls unexposed, disease free), 2017 Autism spectrum disorder (ICD-9 (299), ICD-10 (F84), or DSM-IV (299) codes) at 4-17 years during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No Monotherapy: no or not specified 0.92 [0.38;2.24] C
excluded (control group)
5/264   4,889/238,943 4,894 264
ref
S7827
R23239
Rai (Controls unexposed, sick), 2017 Autism spectrum disorder (ICD-9 (299), ICD-10 (F84), or DSM-IV (299) codes) at 4-17 years during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 0.61 [0.25;1.49] 5/264   353/12,325 358 264
ref
S7640
R22604
Viktorin (Controls unexposed, NOS), 2017 Autism spectrum disorder (ICD10- F84.0, F84.1, F84.2, F84.3, F84.4, F84.5, F84.8, or F84.9) at 7-8 years during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: no or not specified 1.40 [0.52;3.76]
excluded (control group)
4/173   1,524/172,646 1,528 173
ref
S7823
R23231
Viktorin (Controls unexposed, sick), 2017 Autism spectrum disorder (ICD10- F84.0, F84.1, F84.2, F84.3, F84.4, F84.5, F84.8, or F84.9) at 7-8 years during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 1.21 [0.38;3.80] 3/108   -/- - 108
ref
S7863
R23797
Bérard, 2016 Autism spectrum disorder (ICD-9 codes 299.0, 299.8, 299.9; ICD-10 codes F84.0, F84.1, F84.5, F84.8, F84.9) - Age : 0-11 years (mean: 4.0) 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.99 [1.00;3.96] 11/744   1,004/142,716 1,015 744
ref
Total 5 studies 1.33 [0.80;2.21] 1,373 2,098
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 Heuvelman, 2023Heuvelman, 2023 2.04[1.31; 3.16]-98232%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: criticalROB mesure: criticalROB reporting: low Brown, 2017Brown, 2017 0.72[0.22; 2.38]--13%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Rai (Controls unexposed, sick), 2017Rai, 2017 1 0.61[0.25; 1.49]35826418%ROB confusion: unclearROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Viktorin (Controls unexposed, sick), 2017Viktorin, 2017 2 1.21[0.38; 3.80]-10813%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Bérard, 2016Bérard, 2016 1.99[1.00; 3.96]1,01574424%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: criticalROB reporting: moderate Total (5 studies) I2 = 50% 1.33[0.80; 2.21]1,3732,0980.25.01.0ROB: 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 1.33[0.80; 2.21]1,3732,09850%NAHeuvelman, 2023 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.35[0.51; 3.56]1,01574452%NABrown, 2017 Bérard, 2016 2 unexposed, sickunexposed, sick 1.23[0.56; 2.72]3581,35466%NAHeuvelman, 2023 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 3 Tags Adjustment   - Yes  - Yes 1.33[0.80; 2.21]1,3732,09850%NAHeuvelman, 2023 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 5 Monotherapy   - no or not specified  - no or not specified 1.12[0.57; 2.21]3581,35459%NAHeuvelman, 2023 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 4   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.99[1.00; 3.96]1,015744 -NABérard, 2016 1 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 2.04[1.31; 3.17]-982 -NAHeuvelman, 2023 1   - old history of illness/treatment (> ...  - old history of illness/treatment (> 12 months before pregnancy) or not specified 0.79[0.39; 1.60]3583720%NARai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 2 All studiesAll studies 1.33[0.80; 2.21]1,3732,09850%NAHeuvelman, 2023 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 50.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.41.70.7290.000Heuvelman, 2023Brown, 2017Rai (Controls unexposed, sick), 2017Viktorin (Controls unexposed, sick), 2017Bérard, 2016

Asymetry test p-value = 0.1143 (by Egger's regression)

slope=1.3321 (0.4342); intercept=-2.6557 (1.2028); t=2.2079; p=0.1143

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 11336, 7483, 7640

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.33[0.86; 2.07]7,4371,1810%NABrown, 2017 Rai (Controls unexposed, disease free), 2017 Viktorin (Controls unexposed, NOS), 2017 Bérard, 2016 4 unexposed, sick controlsunexposed, sick controls 1.23[0.56; 2.72]3581,35466%NAHeuvelman, 2023 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls Out of scale0.26[0.10; 0.73]21264 -NARai (Controls exposed to TCA), 2017 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Halvorsen (Autism spectrum disorder _ Cohort ...Halvorsen (Autism spectrum disorder _ Cohort studies) 1.07[0.50; 2.29]0%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT2 metaPregmetaPreg 1.33[0.80; 2.21]50%2,098----Heuvelman, 2023 Brown, 2017 Rai (Controls unexposed, sick), 2017 Viktorin (Controls unexposed, sick), 2017 Bérard, 2016 50.510.01.0