Benzodiazepines (Psy and mixed indications) updated on 02-10-2025

ASD (Autism spectrum disorder): Diagnosis

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.
S15397
R63468
Chan - BZDs, 2023 Autism spectrum disorder (ASD) - ICD-9-CM: 299 - Median follow-up time of 8.76 years during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes BZD Coexposure: Yes (with psychiatric (ATD and/or psychotropics) medications) 1.42 [1.06;1.90] -/-   -/- - -
ref
S17870
R75493
Delteil - BZDs (Controls unexposed, NOS), 2023 Pervasive developmental disorders (ICD-10: F84.0; F84.1; F84.5 and F84.8) - At 5 and/or 8 years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: Yes BZD Coexposure: Yes (with psychiatric (ATD and/or psychotropics) medications) 1.33 [0.86;2.05]
excluded (control group)
23/2,183   481/72,294 504 2,183
ref
S15610
R75485
Delteil - BZDs (Controls unexposed, sick), 2023 Pervasive developmental disorders (ICD-10: F84.0; F84.1; F84.5 and F84.8) - At 5 and/or 8 years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes BZD Coexposure: Yes (with psychiatric (ATD and/or psychotropics) medications) 1.03 [0.50;2.14] 23/2,183   11/1,179 34 2,183
ref
S15459
R63562
Bjørk - Clonazepam (Mixed indications), 2022 Diagnosis autism spectrum disorder (ASD): childhood autism (F84.0), atypical autism (F84.1), and Asperger syndrome (F84.5) - Median follow up clonazepam 9.5 (5.5-13.9) years old during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes BZD Coexposure: No (among antiseizure medications) 1.43 [0.96;2.12] 25/1,182   38,437/4,463,879 38,462 1,182
ref
S15460
R63569
Chen - BZDs (Controls unexposed, NOS), 2022 Autism spectrum disorder ASD (ICD-9 code 299; ICD-10 code F84) - At mean 8.5 (3.2) years. 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: Yes BZD Coexposure: Not specified 0.96 [0.89;1.03]
excluded (control group)
754/70,451   13,276/1,440,435 14,030 70,451
ref
S15638
R64540
Chen - BZDs (Controls unexposed, sibling), 2022 Autism spectrum disorder ASD (ICD-9 code 299; ICD-10 code F84) - At mean 8.5 (3.2) years. 1st trimester retrospective cohort (claims database) sibling excluded Adjustment: Yes BZD Coexposure: Not specified 0.92 [0.75;1.14]
excluded (control group)
-/26,652   -/29,233 - 26,652
ref
S17008
R71235
Chen - BZDs (Controls unexposed, sick), 2022 Autism spectrum disorder ASD (ICD-9 code 299; ICD-10 code F84) - At mean 8.5 (3.2) years. 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes BZD Coexposure: Not specified 0.72 [0.60;0.87] -/8,492   -/30,832 - 8,492
ref
S15584
R64111
Coste - Clonazepam (Mixed indications), 2020 Diagnosis Pervasive developmental disorders (F84) - Mean age follow-up 4.4 years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes BZD Coexposure: No (among antiseizure medications) 1.10 [0.50;2.10] 8/1,246   4,280/1,710,441 4,288 1,246
ref
Total 5 studies 1.10 [0.75;1.61] 42,784 13,103
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 Chan - BZDs, 2023Chan - BZDs, 2023 1.42[1.06; 1.90]--24%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Delteil - BZDs (Controls unexposed, sick), 2023Delteil - BZDs, 2023 1 1.03[0.50; 2.14]342,18314%ROB confusion: seriousROB selection: unclearROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Bjørk - Clonazepam (Mixed indications), 2022Bjørk - Clonazepam, 2022 2 1.43[0.96; 2.12]38,4621,18222%ROB confusion: moderateROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Chen - BZDs (Controls unexposed, sick), 2022Chen - BZDs, 2022 3 0.72[0.60; 0.87]-8,49226%ROB confusion: moderateROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Coste - Clonazepam (Mixed indications), 2020Coste - Clonazepam, 2020 4 1.10[0.50; 2.10]4,2881,24614%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: moderateROB mesure: criticalROB reporting: moderate Total (5 studies) I2 = 80% 1.10[0.75; 1.61]42,78413,1030.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Mixed indications; 3: Controls unexposed, sick; 4: Mixed indications;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.10[0.75; 1.61]42,78413,10380%NAChan - BZDs, 2023 Delteil - BZDs (Controls unexposed, sick), 2023 Bjørk - Clonazepam (Mixed indications), 2022 Chen - BZDs (Controls unexposed, sick), 2022 Coste - Clonazepam (Mixed indications), 2020 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.39[1.11; 1.74]42,7502,4280%NAChan - BZDs, 2023 Bjørk - Clonazepam (Mixed indications), 2022 Coste - Clonazepam (Mixed indications), 2020 3 unexposed, sickunexposed, sick 0.74[0.61; 0.88]3410,6750%NADelteil - BZDs (Controls unexposed, sick), 2023 Chen - BZDs (Controls unexposed, sick), 2022 2 Tags Adjustment   - Yes  - Yes 1.10[0.75; 1.61]42,78413,10380%NAChan - BZDs, 2023 Delteil - BZDs (Controls unexposed, sick), 2023 Bjørk - Clonazepam (Mixed indications), 2022 Chen - BZDs (Controls unexposed, sick), 2022 Coste - Clonazepam (Mixed indications), 2020 5 BZD Coexposure   - No (among antiseizure medications)  - No (among antiseizure medications) 1.34[0.95; 1.90]42,7502,4280%NABjørk - Clonazepam (Mixed indications), 2022 Coste - Clonazepam (Mixed indications), 2020 2   - Not specified  - Not specified 0.72[0.60; 0.87]-8,492 -NAChen - BZDs (Controls unexposed, sick), 2022 1   - Yes (with psychiatric (ATD and/or p ...  - Yes (with psychiatric (ATD and/or psychotropics) medications) 1.36[1.04; 1.78]342,1830%NAChan - BZDs, 2023 Delteil - BZDs (Controls unexposed, sick), 2023 2 All studiesAll studies 1.10[0.75; 1.61]42,78413,10380%NAChan - BZDs, 2023 Delteil - BZDs (Controls unexposed, sick), 2023 Bjørk - Clonazepam (Mixed indications), 2022 Chen - BZDs (Controls unexposed, sick), 2022 Coste - Clonazepam (Mixed indications), 2020 50.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-0.91.00.4450.000Chan - BZDs, 2023Delteil - BZDs (Controls unexposed, sick), 2023Bjørk - Clonazepam (Mixed indications), 2022Chen - BZDs (Controls unexposed, sick), 2022Coste - Clonazepam (Mixed indications), 2020

Asymetry test p-value = 0.3413 (by Egger's regression)

slope=-0.3874 (0.3318); intercept=2.3416 (2.0756); t=1.1282; p=0.3413

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 15460, 15638, 17870

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.20[0.95; 1.53]57,28475,06266%NAChan - BZDs, 2023 Delteil - BZDs (Controls unexposed, NOS), 2023 Bjørk - Clonazepam (Mixed indications), 2022 Chen - BZDs (Controls unexposed, NOS), 2022 Coste - Clonazepam (Mixed indications), 2020 5 unexposed, sick controlsunexposed, sick controls 0.74[0.61; 0.88]3410,6750%NADelteil - BZDs (Controls unexposed, sick), 2023 Chen - BZDs (Controls unexposed, sick), 2022 2 siblingssiblings 0.92[0.75; 1.13]-26,652 -NAChen - BZDs (Controls unexposed, sibling), 2022 10.510.01.0