Citalopram 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.
S18431
R78048		 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, ...) 0.69 [0.04;12.52] C
excluded (control group) 		0/81   5/613 5 81
ref
S18412
R77785		 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: No Monotherapy: substance alone among all Antidep (SSRI, SNRI, ...) 1.67 [0.10;26.88] C 0/81   1,721/463,440 1,721 81
ref
S18217
R76437		 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, ...) 2.21 [2.00;2.43] 512/15,496   30,996/2,078,011 31,508 15,496
ref
S13120
R50015		 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, ...) 1.21 [0.80;1.83] C 56/385   50/406 106 385
ref
S7696
R22836		 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, ...) 2.61 [1.55;4.40] -/215   780/24,402 - 215
ref
S7179
R20200		 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, ...) 1.37 [0.86;2.16] 19/1,157   1,144/94,561 1,163 1,157
ref
Total 5 studies 1.79 [1.28;2.48] 34,498 17,334
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 1.67[0.10; 26.88]1,721811%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Martin, 2024Martin, 2024 2.21[2.00; 2.43]31,50815,49635%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Marks (Controls exposed to Bupropion), 2021Marks, 2021 2 1.21[0.80; 1.83]10638523%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Kivistö, 2016Kivistö, 2016 2.61[1.55; 4.40]-21519%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Colvin, 2011Colvin, 2011 1.37[0.86; 2.16]1,1631,15721%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 67% 1.79[1.28; 2.48]34,49817,3340.510.01.0ROB: 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 1.79[1.28; 2.48]34,49817,33467%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 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.06[1.60; 2.64]34,39216,94933%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Colvin, 2011 4 exposed to other treatment, sickexposed to other treatment, sick 1.21[0.80; 1.83]106385 -NAMarks (Controls exposed to Bupropion), 2021 1 Tags Adjustment   - No  - No 1.28[0.95; 1.74]2,9901,6230%NALee (Controls unexposed, general pop), 2025 Marks (Controls exposed to Bupropion), 2021 Colvin, 2011 3   - Yes  - Yes 2.22[2.02; 2.45]31,50815,7110%NAMartin, 2024 Kivistö, 2016 2 Monotherapy   - substance alone among all Antidep ( ...  - substance alone among all Antidep (SSRI, SNRI, ...) 1.92[1.33; 2.77]33,33516,17764%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 4   - substance alone among the specific ...  - substance alone among the specific class of antidep (SSRI, SNRI, ...) 1.37[0.86; 2.17]1,1631,157 -NAColvin, 2011 1 All studiesAll studies 1.79[1.28; 2.48]34,49817,33467%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 50.510.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.33.91.7030.000Lee (Controls unexposed, general pop), 2025Martin, 2024Marks (Controls exposed to Bupropion), 2021Kivistö, 2016Colvin, 2011

Asymetry test p-value = 0.3415 (by Egger's regression)

slope=0.8354 (0.1092); intercept=-1.1821 (1.0482); t=1.1278; p=0.3415

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 18431

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.06[1.60; 2.64]35,16316,94933%NALee (Controls unexposed, general pop), 2025 Martin, 2024 Kivistö, 2016 Colvin, 2011 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.20[0.80; 1.80]1114660%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) 1.00[0.40; 2.70]-U,GPunexposed (general population or NOS)Anyduring pregnancy (anytime or not specified)studies TTT8 Vlenterie (Low 5-min Apgar score)Vlenterie (Low 5-min Apgar score) 0.80[0.30; 2.00]-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT8 Xing (Low Apgar score at 5 min)Xing (Low Apgar score at 5 min) 1.87[0.99; 3.51]70%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT2 metaPregmetaPreg 1.79[1.28; 2.48]67%17,334----Lee (Controls unexposed, general pop), 2025 Martin, 2024 Marks (Controls exposed to Bupropion), 2021 Kivistö, 2016 Colvin, 2011 50.510.01.0