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

Small for gestational age (weight)

id	Study   Auto Lee (Controls exposed to TCAs), 2025Lee (Controls unexposed, general pop), 2025Raviv, 2025Martin - Sertraline, 2024Benevent, 2023Gover, 2023Rommel, 2022Richardson, 2019Giardinelli (Controls unexposed, disease free), 2018Giardinelli (Controls unexposed, sick), 2018Bracero, 2016Kivistö, 2016Hannerfors (Controls unexposed, NOS), 2015Hannerfors (Controls unexposed, sick), 2015Malm (Controls unexposed, disease free), 2015Malm (Controls unexposed, sick), 2015El Marroun (Controls unexposed, disease free), 2012Grzeskowiak a (Controls unexposed, disease free), 2012Grzeskowiak a (Controls unexposed, sick), 2012Nordeng (Controls unexposed, NOS), 2012Nordeng (Controls unexposed, sick), 2012Roca, 2011Reis (Controls exposed to TCA), 2010Reis (Controls unexposed, NOS), 2010Calderon-Margalit, 2009Davidson, 2009Toh b, 2009Zeskind, 2004Chambers - Fluoxetine, 1996	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.
S18442 R78276	Lee (Controls exposed to TCAs), 2025	Small for gestational age (birth weight <2 standard deviations below the mean for gestational age)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: No Monotherapy: SSRI only	0.83 [0.45;1.56] C excluded (control group)	30/1,465   15/613	45	1,465		ref
S18408 R77698	Lee (Controls unexposed, general pop), 2025	Small for gestational age (birth weight <2 standard deviations below the mean for gestational age)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	1.14 [0.78;1.68]	30/1,465   6,986/463,440	7,016	1,465		ref
S18131 R76223	Raviv, 2025	Small for gestational age (birthweight z-scores <−1.28)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	1.75 [1.55;1.97] C	312/2,321   8,453/103,607	8,765	2,321		ref
S18216 R76433	Martin - Sertraline, 2024	Small for gestational age (SGA, defined as those with a birth weight in the lowest 10 percentiles for gestational age (<10th percentile)	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...)	0.98 [0.94;1.02]	3,123/30,355   229,066/2,408,707	232,189	30,355		ref
S12482 R47054	Benevent, 2023	Small for gestational age	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: No Monotherapy: SSRI only	1.65 [1.14;2.37] C	30/1,407   1,682/128,692	1,712	1,407		ref
S14988 R61339	Gover, 2023	Small for gestational age	throughout pregnancy	retrospective cohort	unexposed (general population or NOS)	Adjustment: No Matched Monotherapy: no or not specified	2.11 [0.18;25.17] C	2/21   1/21	3	21		ref
S18233 R76474	Rommel, 2022	Small for gestational age	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, sick	Adjustment: Yes Monotherapy: SSRI only Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy)	0.99 [0.91;1.08]	-/16,429   -/23,676	-	16,429		ref
S7479 R22388	Richardson, 2019	Small for gestational age	during pregnancy (anytime or not specified)	prospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	1.45 [0.99;2.12] C	55/438   65/722	120	438		ref
S7921 R23967	Giardinelli (Controls unexposed, disease free), 2018	Small for gestational age (SD< 2.0)	during pregnancy (anytime or not specified)	prospective cohort	unexposed, disease free excluded	Adjustment: No Monotherapy: no or not specified	4.00 [0.72;22.18] C excluded (control group)	6/24   2/26	8	24		ref
S7916 R23958	Giardinelli (Controls unexposed, sick), 2018	Small for gestational age (SD< 2.0)	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)	1.20 [0.31;4.65] C	6/24   5/23	11	24		ref
S10062 R36571	Bracero, 2016	Small for gestational age (NOS)	days before delivery excluded	retrospective cohort	unexposed, sick	Adjustment: No Monotherapy: no or not specified	2.40 [0.45;12.71] C excluded (exposition period)	3/6   25/85	28	6		ref
S7570 R22774	Kivistö, 2016	Small for gestational age ( birthweight < 10th centile)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	0.80 [0.53;1.18]	29/358   2,336/24,402	2,365	358		ref
S13017 R49397	Hannerfors (Controls unexposed, NOS), 2015	Small for gestational age (NOS)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS) excluded	Adjustment: No Monotherapy: no or not specified	2.38 [0.63;8.95] C excluded (control group)	4/207   5/609	9	207		ref
S13016 R49389	Hannerfors (Controls unexposed, sick), 2015	Small for gestational age (NOS)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed, sick	Adjustment: No Monotherapy: no or not specified	2.47 [0.13;46.51] C	4/207   0/56	4	207		ref
S6107 R15968	Malm (Controls unexposed, disease free), 2015	Small for gestational age (birth weight more than two standard deviations below national standards for sex and length of gestation)	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, disease free excluded	Adjustment: Yes Monotherapy: no or not specified	0.86 [0.74;0.99] excluded (control group)	393/15,729   673/31,394	1,066	15,729		ref
S5374 R15952	Malm (Controls unexposed, sick), 2015	Small for gestational age (birth weight more than two standard deviations below national standards for sex and length of gestation)	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, sick	Adjustment: Yes Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy)	0.92 [0.77;1.10]	393/15,729   245/9,652	638	15,729		ref
S5411 R15322	El Marroun (Controls unexposed, disease free), 2012	Small for gestational age	during pregnancy (anytime or not specified)	prospective cohort	unexposed, disease free	Adjustment: No Monotherapy: no or not specified	0.89 [0.28;2.87]	-/99   -/7,027	-	99		ref
S5961 R15334	Grzeskowiak a (Controls unexposed, disease free), 2012	Small for gestational age (percentage optimal birth weight score less than the 10th)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed, disease free excluded	Adjustment: Yes Monotherapy: SSRI only	1.17 [0.71;1.94] excluded (control group)	19/221   2,205/32,004	2,224	221		ref
S5367 R15329	Grzeskowiak a (Controls unexposed, sick), 2012	Small for gestational age (percentage optimal birth weight score less than the 10th)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed, sick	Adjustment: Yes Monotherapy: SSRI only Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy)	1.13 [0.65;1.94]	19/221   146/1,566	165	221		ref
S496 R17388	Nordeng (Controls unexposed, NOS), 2012	Low birth weight related to gestational age	during pregnancy (anytime or not specified)	cohort	unexposed (general population or NOS) excluded	Adjustment: Yes Monotherapy: no or not specified	0.64 [0.32;1.26] excluded (control group)	17/572   1,598/61,648	1,615	572		ref
S7830 R23253	Nordeng (Controls unexposed, sick), 2012	Low birth weight related to gestational age	during pregnancy (anytime or not specified)	cohort	unexposed, sick	Adjustment: No Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy)	1.00 [0.55;1.83] C	17/572   31/1,048	48	572		ref
S5379 R17677	Roca, 2011	Small for gestational age (birth weight less the 10th centile for gestational age according to local standards)	during pregnancy (anytime or not specified)	prospective cohort	unexposed, disease free	Adjustment: No Matched Monotherapy: no or not specified	0.60 [0.21;1.70] C	5/84   16/168	21	84		ref
S6999 R61423	Reis (Controls exposed to TCA), 2010	Small for gestational age (<2 S.D. from expected weight)	2nd and/or 3rd trimester	population based cohort retrospective	exposed to other treatment, sick excluded	Adjustment: No Monotherapy: SSRI only	1.43 [0.82;2.50] C excluded (control group)	122/4,809   14/784	136	4,809		ref
S5410 R61421	Reis (Controls unexposed, NOS), 2010	Small for gestational age (<2 S.D. from expected weight)	2nd and/or 3rd trimester	population based cohort retrospective	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	1.01 [0.84;1.22]	122/4,809   24,802/1,062,190	24,924	4,809		ref
S5406 R15090	Calderon-Margalit, 2009	Small for Gestational Age infant (birth weight 2 standard deviations below the mean for the newborn’s gestational age at birth)	during pregnancy (anytime or not specified)	prospective cohort	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: no or not specified	1.86 [0.77;4.48]	-/132   -/2,493	-	132		ref
S10040 R36263	Davidson, 2009	Birth weight <10th percentile for age	throughout pregnancy	retrospective cohort	unexposed, disease free	Adjustment: No Matched Monotherapy: no or not specified	7.60 [0.82;70.16] C	6/21   1/20	7	21		ref
S5407 R16707	Toh b, 2009	Small for gestational age (birth weight <10th percentile for gestational age)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	1.68 [1.03;2.74]	21/192   408/5,710	429	192		ref
S10179 R37276	Zeskind, 2004	Small for gestational age (NOS)	throughout pregnancy	retrospective cohort	unexposed (general population or NOS)	Adjustment: No Matched Monotherapy: SSRI only	0.31 [0.01;8.28] C	0/17   1/17	1	17		ref
S490 R15177	Chambers - Fluoxetine, 1996	Birth weight (<10th percentile) in full-term infants	late pregnancy	prospective cohort	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	3.74 [1.26;11.12] C	7/61   7/209	14	61		ref
					Total	21 studies	1.18 [1.02;1.37]		278,432	74,962
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 6999, 5961, 496, 13017, 6107, 7921, 18442

Umbrella review (other published meta-analyses)