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

Intrauterine deaths (as a whole or unspecified)

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.
S7919
R24018
Sjaarda, 2020 Pregnancy loss (any loss occurring after hCG detection of pregnancy) early pregnancy prospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.11 [0.75;1.66] 16/75   143/662 159 75
ref
S493
R15258
Colvin, 2011 Terminations of Pregnancy (both spontaneous abortions and elective) 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.26 [0.91;1.37] 867/3,565   24,313/119,840 25,180 3,565
ref
S5958
R25442
Diav-Citrin - Fluoxetine or Paroxetine, 2008 Intrauterine death (ETOP, Miscarriage, stillbirth, ectopic) during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: No Monotherapy: no or not specified 1.82 [1.42;2.33] C 138/809   149/1,467 287 809
ref
S15011
R61499
Lennestal, 2007 Intrauterine Deaths early pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: no or not specified 1.70 [0.60;3.60] 6/-   3,197/- 3,203 -
ref
S510
R15162
Casper, 2003 Miscarriages during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No Monotherapy: no or not specified Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 0.35 [0.09;1.34] C 9/31   7/13 16 31
ref
Total 5 studies 1.33 [0.99;1.79] 28,845 4,480
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 Sjaarda, 2020Sjaarda, 2020 1.11[0.75; 1.66]1597523%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Colvin, 2011Colvin, 2011 1.26[0.91; 1.37]25,1803,56533%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Diav-Citrin - Fluoxetine or Paroxetine, 2008Diav-Citrin - Fluoxetine or Paroxetine, 2008 1.82[1.42; 2.33]28780931%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: unclearROB reporting: moderate Lennestal, 2007Lennestal, 2007 1.70[0.60; 3.60]3,203-9%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Casper, 2003Casper, 2003 0.35[0.09; 1.34]16314%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 63% 1.33[0.99; 1.79]28,8454,4800.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.33[0.99; 1.79]28,8454,48063%NASjaarda, 2020 Colvin, 2011 Diav-Citrin - Fluoxetine or Paroxetine, 2008 Lennestal, 2007 Casper, 2003 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.41[1.10; 1.82]28,8294,44955%NASjaarda, 2020 Colvin, 2011 Diav-Citrin - Fluoxetine or Paroxetine, 2008 Lennestal, 2007 4 unexposed, sickunexposed, sick 0.35[0.09; 1.34]1631 -NACasper, 2003 1 Tags Adjustment   - No  - No 1.33[0.86; 2.05]25,4834,40578%NAColvin, 2011 Diav-Citrin - Fluoxetine or Paroxetine, 2008 Casper, 2003 3   - Yes  - Yes 1.19[0.83; 1.71]3,362750%NASjaarda, 2020 Lennestal, 2007 2 Monotherapy   - no or not specified  - no or not specified 1.33[0.99; 1.79]28,8454,48063%NASjaarda, 2020 Colvin, 2011 Diav-Citrin - Fluoxetine or Paroxetine, 2008 Lennestal, 2007 Casper, 2003 5 Unexposed sick   - recent illness/treatment (during o ...  - recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 0.35[0.09; 1.34]1631 -NACasper, 2003 1 All studiesAll studies 1.33[0.99; 1.79]28,8454,48063%NASjaarda, 2020 Colvin, 2011 Diav-Citrin - Fluoxetine or Paroxetine, 2008 Lennestal, 2007 Casper, 2003 50.15.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.61.90.8190.000Sjaarda, 2020Colvin, 2011Diav-Citrin - Fluoxetine or Paroxetine, 2008Lennestal, 2007Casper, 2003

Asymetry test p-value = 0.5020 (by Egger's regression)

slope=0.4915 (0.2478); intercept=-1.1467 (1.5067); t=0.7610; p=0.5020

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.41[1.10; 1.82]28,8294,44955%NASjaarda, 2020 Colvin, 2011 Diav-Citrin - Fluoxetine or Paroxetine, 2008 Lennestal, 2007 4 unexposed, sick controlsunexposed, sick controls Out of scale0.35[0.09; 1.34]1631 -NACasper, 2003 10.510.01.0