Phenytoin (Epilepsy)

Microcephaly / Small head circumference for gestational age

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.
S6413
R17574
Pennell (Phenytoin), 2012 Microcephaly at birth (head circumference < 3 percentile) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 0.98 [0.26;3.69] C 4/48   6/71 10 48
ref
S354
R14550
Holmes (Phenytoin) (Controls unexposed, disease free), 2001 Microcephaly at birth (Head circumference more than 2 SD below the mean value for the same race, sex and gestational age) during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free excluded Adjustment: No 0.73 [0.09;5.88] C
excluded (control group)
1/87   8/508 9 87
ref
S5862
R14559
Holmes (Phenytoin) (Controls unexposed, sick), 2001 Microcephaly at birth (Head circumference more than 2 SD below the mean value for the same race, sex and gestational age) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 0.55 [0.05;6.14] C 1/87   2/96 3 87
ref
S6434
R17690
Battino (Phenytoin), 1999 Small head circumferences (at birth < 10th percentile) throughout pregnancy prospective cohort unexposed, sick Adjustment: No 0.57 [0.13;2.45] C 6/100   3/30 9 100
ref
S6776
R19133
Díaz-Romero (Phenytoin), 1999 Head circumference <2 SD at birth (measured by a physician and correlated with sex and with gestational age) during pregnancy (anytime or not specified) cohort unexposed, sick Adjustment: No 0.37 [0.01;20.14] C 0/21   0/8 0 21
ref
S368
R19661
Kelly (Phenytoin), 1984 Microcephaly at unknown age (head circumference < 5th centile) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 0.50 [0.03;8.42] C 1/41   1/21 2 41
ref
Total 5 studies 0.69 [0.30;1.60] 24 297
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 Pennell (Phenytoin), 2012Pennell, 2012 1 0.98[0.26; 3.69]104841%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Holmes (Phenytoin) (Controls unexposed, sick), 2001Holmes, 2001 2 0.55[0.05; 6.14]38712%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Battino (Phenytoin), 1999Battino, 1999 3 0.57[0.13; 2.45]910034%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Díaz-Romero (Phenytoin), 1999Díaz-Romero, 1999 4 0.37[0.01; 20.14]0214%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Kelly (Phenytoin), 1984Kelly, 1984 5 0.50[0.03; 8.42]2419%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (5 studies) I2 = 0% 0.69[0.30; 1.60]242970.22.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Phenytoin; 2: Phenytoin) (Controls unexposed, sick; 3: Phenytoin; 4: Phenytoin; 5: Phenytoin;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.69[0.30; 1.60]242970%NAPennell (Phenytoin), 2012 Holmes (Phenytoin) (Controls unexposed, sick), 2001 Battino (Phenytoin), 1999 Díaz-Romero (Phenytoin), 1999 Kelly (Phenytoin), 1984 5 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 0.54[0.18; 1.61]142490%NAHolmes (Phenytoin) (Controls unexposed, sick), 2001 Battino (Phenytoin), 1999 Díaz-Romero (Phenytoin), 1999 Kelly (Phenytoin), 1984 4 exposed to other treatment, sickexposed to other treatment, sick 0.98[0.26; 3.69]1048 -NAPennell (Phenytoin), 2012 1 Tags Adjustment   - No  - No 0.69[0.30; 1.60]242970%NAPennell (Phenytoin), 2012 Holmes (Phenytoin) (Controls unexposed, sick), 2001 Battino (Phenytoin), 1999 Díaz-Romero (Phenytoin), 1999 Kelly (Phenytoin), 1984 5 All studiesAll studies 0.69[0.30; 1.60]242970%NAPennell (Phenytoin), 2012 Holmes (Phenytoin) (Controls unexposed, sick), 2001 Battino (Phenytoin), 1999 Díaz-Romero (Phenytoin), 1999 Kelly (Phenytoin), 1984 50.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.84.42.4540.000Pennell (Phenytoin), 2012Holmes (Phenytoin) (Controls unexposed, sick), 2001Battino (Phenytoin), 1999Díaz-Romero (Phenytoin), 1999Kelly (Phenytoin), 1984

Asymetry test p-value = 0.1685 (by Egger's regression)

slope=0.1892 (0.3352); intercept=-0.6295 (0.3484); t=1.8070; p=0.1685

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 354

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 0.73[0.09; 5.88]987 -NAHolmes (Phenytoin) (Controls unexposed, disease free), 2001 1 unexposed, sick controlsunexposed, sick controls 0.54[0.18; 1.61]142490%NAHolmes (Phenytoin) (Controls unexposed, sick), 2001 Battino (Phenytoin), 1999 Díaz-Romero (Phenytoin), 1999 Kelly (Phenytoin), 1984 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.98[0.26; 3.69]1048 -NAPennell (Phenytoin), 2012 10.510.01.0