Selective Serotonin Reuptake Inhibitor (SSRI) updated on 07-01-2025

Jaundice / Icterus

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.
S13112
R49965		 Marks - Sertraline (Controls exposed to Bupropion), 2021 Jaundice during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.87 [0.64;1.18] C 228/1,653   63/406 291 1,653
ref
S12918
R49004		 Gungor (Controls exposed to Mirtazapine), 2019 Neonatal bilirubinemia (transient-mild) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No Monotherapy: SSRI only 3.92 [0.97;15.91] C
excluded (control group) 		19/40   3/16 22 40
ref
S8158
R25131		 Gungor (Controls unexposed, disease free), 2019 Neonatal bilirubinemia (transient-mild) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No Monotherapy: SSRI only 4.30 [1.24;14.91] C
excluded (control group) 		19/40   4/23 23 40
ref
S8159
R25137		 Gungor (Controls unexposed, sick), 2019 Neonatal bilirubinemia (transient-mild) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No Monotherapy: SSRI only Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 0.99 [0.35;2.76] C 19/40   11/23 30 40
ref
S5428
R20532		 Colvin, 2012 Neonatal jaundice from other and unspecified causes during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 0.78 [0.66;0.93] 139/3,297   4,604/86,110 4,743 3,297
ref
S7107
R20022		 Källén (Controls exposed to TCA), 2004 Jaundice late pregnancy population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No Monotherapy: SSRI only 0.77 [0.42;1.41] C
excluded (control group) 		23/563   21/400 44 563
ref
S485
R18112		 Källén (Controls unexposed, NOS), 2004 Jaundice late pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 0.96 [0.63;1.46] 23/563   22,715/582,796 22,738 563
ref
Total 4 studies 0.82 [0.71;0.94] 27,802 5,553
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 Marks - Sertraline (Controls exposed to Bupropion), 2021Marks - Sertraline, 2021 1 0.87[0.64; 1.18]2911,65321%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Gungor (Controls unexposed, sick), 2019Gungor, 2019 2 0.99[0.35; 2.76]30402%ROB confusion: seriousROB selection: unclearROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Colvin, 2012Colvin, 2012 0.78[0.66; 0.93]4,7433,29766%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Källén (Controls unexposed, NOS), 2004Källén, 2004 3 0.96[0.63; 1.46]22,73856311%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: NAROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 0.82[0.71; 0.94]27,8025,5530.22.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls exposed to Bupropion; 2: Controls unexposed, sick; 3: Controls unexposed, NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.82[0.71; 0.94]27,8025,5530%NAMarks - Sertraline (Controls exposed to Bupropion), 2021 Gungor (Controls unexposed, sick), 2019 Colvin, 2012 Källén (Controls unexposed, NOS), 2004 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 0.80[0.69; 0.94]27,4813,8600%NAColvin, 2012 Källén (Controls unexposed, NOS), 2004 2 unexposed, sickunexposed, sick 0.99[0.35; 2.76]3040 -NAGungor (Controls unexposed, sick), 2019 1 exposed to other treatment, sickexposed to other treatment, sick 0.87[0.64; 1.18]2911,653 -NAMarks - Sertraline (Controls exposed to Bupropion), 2021 1 Tags Adjustment   - No  - No 0.80[0.69; 0.93]5,0644,9900%NAMarks - Sertraline (Controls exposed to Bupropion), 2021 Gungor (Controls unexposed, sick), 2019 Colvin, 2012 3   - Yes  - Yes 0.96[0.63; 1.46]22,738563 -NAKällén (Controls unexposed, NOS), 2004 1 Monotherapy   - no or not specified  - no or not specified 0.78[0.66; 0.93]4,7433,297 -NAColvin, 2012 1   - SSRI only  - SSRI only 0.96[0.65; 1.42]22,7686030%NAGungor (Controls unexposed, sick), 2019 Källén (Controls unexposed, NOS), 2004 2   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 0.87[0.64; 1.18]2911,653 -NAMarks - Sertraline (Controls exposed to Bupropion), 2021 1 Unexposed sick   - old history of illness/treatment (> ...  - old history of illness/treatment (> 12 months before pregnancy) or not specified 0.99[0.35; 2.76]3040 -NAGungor (Controls unexposed, sick), 2019 1 All studiesAll studies 0.82[0.71; 0.94]27,8025,5530%NAMarks - Sertraline (Controls exposed to Bupropion), 2021 Gungor (Controls unexposed, sick), 2019 Colvin, 2012 Källén (Controls unexposed, NOS), 2004 40.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.21.00.6290.000Marks - Sertraline (Controls exposed to Bupropion), 2021Gungor (Controls unexposed, sick), 2019Colvin, 2012Källén (Controls unexposed, NOS), 2004

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 7107, 12918, 8158

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.05[0.63; 1.77]27,5043,90074%NAGungor (Controls unexposed, disease free), 2019 Colvin, 2012 Källén (Controls unexposed, NOS), 2004 3 unexposed, sick controlsunexposed, sick controls 0.99[0.35; 2.76]3040 -NAGungor (Controls unexposed, sick), 2019 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.00[0.58; 1.74]3572,25656%NAMarks - Sertraline (Controls exposed to Bupropion), 2021 Gungor (Controls exposed to Mirtazapine), 2019 Källén (Controls exposed to TCA), 2004 30.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Wang - SSRI (Jaundice)Wang - SSRI (Jaundice) 0.80[0.65; 0.98]0%-Wwhatever (meta-analysis)T33rd trimesterstudies TTT2 metaPregmetaPreg 0.82[0.71; 0.94]0%5,553----Marks - Sertraline (Controls exposed to Bupropion), 2021 Gungor (Controls unexposed, sick), 2019 Colvin, 2012 Källén (Controls unexposed, NOS), 2004 40.510.01.0