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

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.
S15405
R63476
Lee - Alprazolam, 2022 Apgar score at 5 min (7 or less) 1st trimester excluded prospective cohort unexposed (general population or NOS) Adjustment: Yes BZD Coexposure: Not specified 3.68 [0.85;16.00]
excluded (exposition period)
3/61   6/461 9 61
ref
S15319
R63024
Freeman - BZDs, 2018 Low 5-minute Apgar (< 7) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: Yes BZD Coexposure: Yes (with psychiatric (ATD and/or psychotropics) medications) Indication BZD: Psychiatric diseases (depression, anxiety, ...) 4.91 [0.69;34.96] 6/108   12/378 18 108
ref
S15312
R63003
Christensen - Clonazepam (Mixed indications), 2015 Low Apgar score (≤ 7) at 5 min during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: No BZD Coexposure: No (among antiseizure medications) 1.47 [0.62;3.51] 5/260   8,797/674,115 8,802 260
ref
S15587
R64172
Källén - BZDs, 2013 Low Apgar score (< 7 at 5min) 2nd and/or 3rd trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes BZD Coexposure: Not specified 2.18 [1.93;2.48] 257/-   -/- - -
ref
S15320
R63035
Calderon-Margalit - BZDs, 2009 APGAR Score at 5 minute <7 during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: Yes BZD Coexposure: Yes (with psychiatric (ATD and/or psychotropics) medications) 3.87 [1.53;9.76] 7/85   37/2,493 44 85
ref
Total 4 studies 2.19 [1.94;2.48] 8,864 453
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 Freeman - BZDs, 2018Freeman - BZDs, 2018 4.91[0.69; 34.96]181080%ROB confusion: seriousROB selection: unclearROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Christensen - Clonazepam (Mixed indications), 2015Christensen - Clonazepam, 2015 1 1.47[0.62; 3.51]8,8022602%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Källén - BZDs, 2013Källén - BZDs, 2013 2.18[1.93; 2.48]--96%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Calderon-Margalit - BZDs, 2009Calderon-Margalit - BZDs, 2009 3.87[1.53; 9.76]44852%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 2.19[1.94; 2.48]8,8644530.510.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Mixed indications;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.19[1.94; 2.48]8,8644530%NAFreeman - BZDs, 2018 Christensen - Clonazepam (Mixed indications), 2015 Källén - BZDs, 2013 Calderon-Margalit - BZDs, 2009 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.20[1.72; 2.81]8,84634512%NAChristensen - Clonazepam (Mixed indications), 2015 Källén - BZDs, 2013 Calderon-Margalit - BZDs, 2009 3 unexposed, sickunexposed, sick 4.91[0.69; 34.95]18108 -NAFreeman - BZDs, 2018 1 Tags Adjustment   - No  - No 1.47[0.62; 3.50]8,802260 -NAChristensen - Clonazepam (Mixed indications), 2015 1   - Yes  - Yes 2.26[1.84; 2.79]621934%NAFreeman - BZDs, 2018 Källén - BZDs, 2013 Calderon-Margalit - BZDs, 2009 3 BZD Coexposure   - No (among antiseizure medications)  - No (among antiseizure medications) 1.47[0.62; 3.50]8,802260 -NAChristensen - Clonazepam (Mixed indications), 2015 1   - Not specified  - Not specified 2.18[1.92; 2.47]-- -NAKällén - BZDs, 2013 1   - Yes (with psychiatric (ATD and/or p ...  - Yes (with psychiatric (ATD and/or psychotropics) medications) 4.04[1.75; 9.34]621930%NAFreeman - BZDs, 2018 Calderon-Margalit - BZDs, 2009 2 Indication BZD   - Psychiatric diseases (depression, a ...  - Psychiatric diseases (depression, anxiety, ...) 4.91[0.69; 34.95]18108 -NAFreeman - BZDs, 2018 1 All studiesAll studies 2.19[1.94; 2.48]8,8644530%NAFreeman - BZDs, 2018 Christensen - Clonazepam (Mixed indications), 2015 Källén - BZDs, 2013 Calderon-Margalit - BZDs, 2009 40.510.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.43.11.2020.000Freeman - BZDs, 2018Christensen - Clonazepam (Mixed indications), 2015Källén - BZDs, 2013Calderon-Margalit - BZDs, 2009

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

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.20[1.72; 2.81]9,09434512%NAChristensen - Clonazepam (Mixed indications), 2015 Källén - BZDs, 2013 Calderon-Margalit - BZDs, 2009 3 unexposed, sick controlsunexposed, sick controls 4.91[0.69; 34.95]18108 -NAFreeman - BZDs, 2018 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Grigoriadis - BZDs (Low Apgar scores at 5 min)Grigoriadis - BZDs (Low Apgar scores at 5 min) 2.19[1.94; 2.47]0%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT4 metaPregmetaPreg 2.19[1.94; 2.48]0%453----Freeman - BZDs, 2018 Christensen - Clonazepam (Mixed indications), 2015 Källén - BZDs, 2013 Calderon-Margalit - BZDs, 2009 40.510.01.0