Sertraline updated on 07-01-2025

Low Apgar score (< 7) (at 5 min)

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.
S18438
R78195		 Lee (Controls exposed to TCAs), 2025 5-minute Apgar score<7 during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.38 [0.07;1.96] C
excluded (control group) 		2/643   5/613 7 643
ref
S18420
R77953		 Lee (Controls unexposed, general pop), 2025 5-minute Apgar score<7 during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.65 [0.16;2.68] 2/643   1,721/463,440 1,723 643
ref
S18304
R77083		 Martin, 2024 Low Apgar score at 5 min (<7) 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, ...) 1.96 [1.82;2.10] 979/31,719   30,996/2,078,011 31,975 31,719
ref
S12953
R49159		 Heinonen, 2021 Low Apgar score (at 5 min) 3rd trimester randomized controlled trial unexposed, sick Adjustment: Randomisation Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 0.33 [0.01;21.64] C 0/8   0/3 0 8
ref
S13130
R50075		 Marks (Controls exposed to Bupropion), 2021 5 Min APGAR <7 during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick Adjustment: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.05 [0.76;1.46] C 213/1,653   50/406 263 1,653
ref
S7699
R22871		 Kivistö, 2016 Low (<7) Apgar score at 5 min during pregnancy (anytime or not specified) retrospective cohort unexposed (general population or NOS) Adjustment: Yes Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 3.24 [1.13;9.23] -/49   780/24,402 - 49
ref
S7178
R20159		 Colvin, 2011 APGAR 5-minutes <6 during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Monotherapy: substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.59 [1.08;2.36] 26/1,361   1,144/94,561 1,170 1,361
ref
Total 6 studies 1.53 [1.06;2.21] 35,131 35,433
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 Lee (Controls unexposed, general pop), 2025Lee, 2025 1 0.65[0.16; 2.68]1,7236436%ROB confusion: moderateROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Martin, 2024Martin, 2024 1.96[1.82; 2.10]31,97531,71934%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Heinonen, 2021Heinonen, 2021 0.33[0.01; 21.64]081%ROB confusion: unclearROB selection: lowROB classification: lowROB missing: criticalROB mesure: lowROB reporting: low Marks (Controls exposed to Bupropion), 2021Marks, 2021 2 1.05[0.76; 1.46]2631,65327%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Kivistö, 2016Kivistö, 2016 3.24[1.13; 9.23]-499%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Colvin, 2011Colvin, 2011 1.59[1.08; 2.36]1,1701,36124%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (6 studies) I2 = 72% 1.53[1.06; 2.21]35,13135,4330.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, general pop; 2: Controls exposed to Bupropion;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.55[1.07; 2.24]35,13135,42577%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 5 case control studiescase control studies 0 RCTRCT 0.33[0.01; 21.64]-8 -NAHeinonen, 2021 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.85[1.45; 2.36]34,86833,77230%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Colvin, 2011 4 unexposed, sickunexposed, sick 0.33[0.01; 21.64]-8 -NAHeinonen, 2021 1 exposed to other treatment, sickexposed to other treatment, sick 1.05[0.76; 1.46]2631,653 -NAMarks (Controls exposed to Bupropion), 2021 1 Tags Adjustment   - No  - No 1.28[0.85; 1.91]1,4333,01460%NAMarks (Controls exposed to Bupropion), 2021 Colvin, 2011 2   - Randomisation  - Randomisation 0.33[0.01; 21.64]-8 -NAHeinonen, 2021 1   - Yes  - Yes 1.88[1.09; 3.27]33,69832,41138%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 3 Monotherapy   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.49[0.90; 2.47]33,96134,07276%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Heinonen, 2021 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 5   - substance alone among the specific ...  - substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.59[1.08; 2.35]1,1701,361 -NAColvin, 2011 1 All studiesAll studies 1.53[1.06; 2.21]35,13135,43372%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Heinonen, 2021 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 60.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-5.05.42.5550.000Lee (Controls unexposed, general pop), 2025Martin, 2024Heinonen, 2021Marks (Controls exposed to Bupropion), 2021Kivistö, 2016Colvin, 2011

Asymetry test p-value = 0.2338 (by Egger's regression)

slope=0.7022 (0.0756); intercept=-1.2350 (0.8815); t=1.4010; p=0.2338

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 18438

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.85[1.45; 2.36]35,63933,77230%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Colvin, 2011 4 unexposed, sick controlsunexposed, sick controls Out of scale0.33[0.01; 21.64]-8 -NAHeinonen, 2021 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.88[0.41; 1.89]2702,29630%NALee (Controls exposed to TCAs), 2025 Marks (Controls exposed to Bupropion), 2021 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Vlenterie (Low 5-min Apgar score)Vlenterie (Low 5-min Apgar score) 0.60[0.20; 2.70]-U,GPunexposed (general population or NOS)Anyduring pregnancy (anytime or not specified)studies TTT7 Vlenterie (Low 5-min Apgar score)Vlenterie (Low 5-min Apgar score) Out of scale0.50[0.10; 2.10]-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT7 Xing (Low Apgar score at 5 min)Xing (Low Apgar score at 5 min) 1.91[1.04; 3.52]36%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT2 metaPregmetaPreg 1.53[1.06; 2.21]72%35,433----Lee (Controls unexposed, general pop), 2025 Martin, 2024 Heinonen, 2021 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 60.510.01.0