Atypical antipsychotics (Second generation) updated on 06-10-2025

Withdrawal syndrome / Neonatal abstinence syndrome / Poor neonatal adaptation

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.
S14268
R56084		 Viguera b, 2023 At least one poor neonatal adaptation syndrome (PNAS) symptom during the first month of life. during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 0.92 [0.60;1.40] C 63/193   66/191 129 193
ref
S12459
R46742		 Kernizan, 2019 Neonatal abstinence score > 7 during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 0.55 [0.15;1.99] C 3/45   16/140 19 45
ref
S3905
R8281		 Schaffer (Controls unexposed, NOS), 2019 Neonatal abstinence syndrome during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: No 9.04 [7.44;10.98] C
excluded (control group) 		120/1,243   1,558/133,377 1,678 1,243
ref
S3907
R8290		 Schaffer (Controls unexposed, sick), 2019 Neonatal abstinence syndrome during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No 1.24 [0.94;1.62] C 120/1,243   111/1,394 231 1,243
ref
S2294
R8229		 Vigod, 2015 Neonatal adaption syndrome 3rd trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Matched 1.31 [0.91;1.90] 76/1,021   61/1,021 137 1,021
ref
S2286
R2660		 Sadowski, 2013 Poor neonatal adaptation signs during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: No Matched 2.81 [1.05;7.52] C 15/113   6/116 21 113
ref
Total 5 studies 1.19 [0.92;1.55] 537 2,615
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 Viguera b, 2023Viguera b, 2023 0.92[0.60; 1.40]12919324%ROB confusion: criticalROB selection: unclearROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: low Kernizan, 2019Kernizan, 2019 0.55[0.15; 1.99]19454%ROB confusion: criticalROB selection: unclearROB classification: unclearROB missing: unclearROB mesure: unclearROB reporting: critical Schaffer (Controls unexposed, sick), 2019Schaffer, 2019 1 1.24[0.94; 1.62]2311,24338%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Vigod, 2015Vigod, 2015 1.31[0.91; 1.90]1371,02128%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Sadowski, 2013Sadowski, 2013 2.81[1.05; 7.52]211136%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 34% 1.19[0.92; 1.55]5372,6150.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.19[0.92; 1.55]5372,61534%NAViguera b, 2023 Kernizan, 2019 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 Sadowski, 2013 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.81[1.05; 7.52]21113 -NASadowski, 2013 1 unexposed, sickunexposed, sick 1.23[0.99; 1.53]3872,3090%NAKernizan, 2019 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 3 exposed to other treatment, sickexposed to other treatment, sick 0.92[0.60; 1.40]129193 -NAViguera b, 2023 1 Tags Adjustment   - No  - No 1.16[0.78; 1.71]4001,59448%NAViguera b, 2023 Kernizan, 2019 Schaffer (Controls unexposed, sick), 2019 Sadowski, 2013 4   - Yes  - Yes 1.31[0.91; 1.89]1371,021 -NAVigod, 2015 1 MatchedMatched 1.66[0.83; 3.32]1581,13450%NAVigod, 2015 Sadowski, 2013 2 All studiesAll studies 1.19[0.92; 1.55]5372,61534%NAViguera b, 2023 Kernizan, 2019 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 Sadowski, 2013 50.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.51.70.7850.000Viguera b, 2023Kernizan, 2019Schaffer (Controls unexposed, sick), 2019Vigod, 2015Sadowski, 2013

Asymetry test p-value = 0.9886 (by Egger's regression)

slope=0.1848 (0.2977); intercept=-0.0215 (1.3879); t=0.0155; p=0.9886

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 3905

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 5.59[1.81; 17.27]1,6991,35681%NASchaffer (Controls unexposed, NOS), 2019 Sadowski, 2013 2 unexposed, sick controlsunexposed, sick controls 1.23[0.99; 1.53]3872,3090%NAKernizan, 2019 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.92[0.60; 1.40]129193 -NAViguera b, 2023 10.510.01.0