Renin-angiotensin system (ACEIs and/or ARBs) (versus unexposed) updated on 03-11-2025

Caesarean

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.
S17160
R71968
Vaclavik - ACEs/ARBs, 2024 Caesarean section during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.03 [1.61;2.56] -/117   -/252,856 - 117
ref
S17123
R71693
Van der Zande - ACE-Is and/or ARBs, 2024 Caesarean section during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) Renin angiotensin: ARBs and/or ACEIs (Angiotensin II receptor blockers and/or Angiotensin-converting enzyme inhibitors) 1.86 [1.00;3.48] C 26/42   2,655/5,697 2,681 42
ref
S14147
R55485
Hoeltzenbein a - ARBs, 2018 C-section early pregnancy excluded prospective cohort unexposed, disease free Adjustment: No Indications Antihypertensive: Only chronic hypertension indication Matched Renin angiotensin: ARBs (Angiotensin II receptor blockers) 2.26 [1.59;3.22] C
excluded (exposition period)
88/162   193/560 281 162
ref
S14211
R55714
Colvin - ACEi, 2014 Caesarean 1st trimester excluded retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified Renin angiotensin: ACEIs (Angiotensin-converting enzyme inhibitors) 1.77 [0.93;3.37]
excluded (exposition period)
43/83   30,737/95,926 30,780 83
ref
S14158
R55562
Moretti - ACEi/ARBs, 2012 Cesarean section 1st trimester excluded prospective cohort unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched Renin angiotensin: ARBs and/or ACEIs (Angiotensin II receptor blockers and/or Angiotensin-converting enzyme inhibitors) 1.66 [0.97;2.87] C
excluded (exposition period)
46/108   37/120 83 108
ref
Total 2 studies 2.01 [1.62;2.50] 2,681 159
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 Vaclavik - ACEs/ARBs, 2024Vaclavik - ACEs/ARBs, 2024 2.03[1.61; 2.56]-11788%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: unclear Van der Zande - ACE-Is and/or ARBs, 2024Van der Zande - ACE-Is and/or ARBs, 2024 1.86[1.00; 3.48]2,6814212%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Total (2 studies) I2 = 0% 2.01[1.62; 2.50]2,6811590.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.01[1.62; 2.50]2,6811590%NAVaclavik - ACEs/ARBs, 2024 Van der Zande - ACE-Is and/or ARBs, 2024 2 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.03[1.61; 2.56]-117 -NAVaclavik - ACEs/ARBs, 2024 1 unexposed, sickunexposed, sick 1.86[1.00; 3.48]2,68142 -NAVan der Zande - ACE-Is and/or ARBs, 2024 1 Tags Adjustment   - No  - No 2.01[1.62; 2.50]2,6811590%NAVaclavik - ACEs/ARBs, 2024 Van der Zande - ACE-Is and/or ARBs, 2024 2 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 2.03[1.61; 2.56]-117 -NAVaclavik - ACEs/ARBs, 2024 1   - Only cardiac indications other than ...  - Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 1.86[1.00; 3.48]2,68142 -NAVan der Zande - ACE-Is and/or ARBs, 2024 1 Renin angiotensin   - ARBs and/or ACEIs (Angiotensin II r ...  - ARBs and/or ACEIs (Angiotensin II receptor blockers and/or Angiotensin-converting enzyme inhibitors) 1.86[1.00; 3.48]2,68142 -NAVan der Zande - ACE-Is and/or ARBs, 2024 1 All studiesAll studies 2.01[1.62; 2.50]2,6811590%NAVaclavik - ACEs/ARBs, 2024 Van der Zande - ACE-Is and/or ARBs, 2024 20.55.01.0

Publication bias and p-hacking diagnosis

funnel plot

Funnel plot not drawn. Less than 3 points.

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

not enought points

p values plot

Funnel plot not drawn. Less than 3 points.

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) 2.03[1.61; 2.56]-117 -NAVaclavik - ACEs/ARBs, 2024 1 unexposed, sick controlsunexposed, sick controls 1.86[1.00; 3.48]2,68142 -NAVan der Zande - ACE-Is and/or ARBs, 2024 10.510.01.0