Lamotrigine (Epilepsy) updated on 04-22-2025

Cognitive developmental disorders/delay (3-6 years old)

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.
S19477
R83185
Straub (Lamotrigine) (Epilepsy), 2026 Intellectual disability - ICD-10 codes: F70-F79 - Mean follow up (full cohort): 3.4 years during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes 2.46 [1.16;5.24] 12/3,273   26/8,887 38 3,273
ref
S12723
R73454
Bjørk (Controls unexposed, NOS), 2022 Diagnosis of intellectual disability (ID): mild ID (F70), moderate ID (F71), severe ID (F72), and profound ID (F73) - Median follow up lamotrigine 5.1 (2.4-8.5) years old during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: No 1.13 [0.73;1.73] C
excluded (control group)
21/5,073   16,384/4,463,879 16,405 5,073
ref
S12722
R73455
Bjørk (Controls unexposed, sick), 2022 Diagnosis of intellectual disability (ID): mild ID (F70), moderate ID (F71), severe ID (F72), and profound ID (F73) - Median follow up lamotrigine 5.1 (2.4-8.5) years old during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes 0.73 [0.46;1.16] 21/5,073   139/21,634 160 5,073
ref
S7277
R48894
Kasradze, 2017 Full scale IQ - Wechsler Preschool and Primary Scale of Intelligence (WPPSI-4) (mean age 4-4.5 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: No extrapolated (cont. endpoint) Matched 30.10 [3.28;276.62] -/3   -/50 - 3
ref
S6295
R48895
Rihtman, 2013 Stanford Binet Intelligence Scales, Fifth Edition (SB5) - GIQ (mean age 4-5 years old) at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No extrapolated (cont. endpoint) 1.65 [0.78;3.49] -/41   -/52 - 41
ref
S6940
R48893
Cummings, 2011 Mild or significant delay (score ≥1, <2 SD or ≥2 SD below the mean) (Bayley Scales of Infant Development or the Griffiths Scale) (mean age in years: m1=2.7 and m0=4.3) throughout pregnancy retrospective cohort (registry) unexposed, disease free Adjustment: Yes 1.10 [0.10;13.70] 1/35   2/44 3 35
ref
Total 5 studies 1.88 [0.79;4.50] 201 8,425
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 Straub (Lamotrigine) (Epilepsy), 2026Straub, 2026 1 2.46[1.16; 5.24]383,27326%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: criticalROB reporting: moderate Bjørk (Controls unexposed, sick), 2022Bjørk, 2022 2 0.73[0.46; 1.16]1605,07329%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Kasradze, 2017Kasradze, 2017 30.10[3.28; 276.62]-310%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: criticalROB mesure: lowROB reporting: moderate Rihtman, 2013Rihtman, 2013 1.65[0.78; 3.49]-4126%ROB confusion: moderateROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Cummings, 2011Cummings, 2011 1.10[0.10; 13.70]3359%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: lowROB reporting: moderate Total (5 studies) I2 = 76% 1.88[0.79; 4.50]2018,4250.2100.01.0ROB: A: confounding, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Lamotrigine) (Epilepsy; 2: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.88[0.79; 4.50]2018,42576%NAStraub (Lamotrigine) (Epilepsy), 2026 Bjørk (Controls unexposed, sick), 2022 Kasradze, 2017 Rihtman, 2013 Cummings, 2011 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 3.39[0.56; 20.57]37968%NAKasradze, 2017 Rihtman, 2013 Cummings, 2011 3 unexposed, sickunexposed, sick 1.29[0.39; 4.23]1988,34686%NAStraub (Lamotrigine) (Epilepsy), 2026 Bjørk (Controls unexposed, sick), 2022 2 Tags Adjustment   - No  - No 5.80[0.35; 97.25]-4483%NAKasradze, 2017 Rihtman, 2013 2   - Yes  - Yes 1.25[0.47; 3.38]2018,38172%NAStraub (Lamotrigine) (Epilepsy), 2026 Bjørk (Controls unexposed, sick), 2022 Cummings, 2011 3 extrapolated (cont. endpoint)extrapolated (cont. endpoint) 5.80[0.35; 97.25]-4483%NAKasradze, 2017 Rihtman, 2013 2 MatchedMatched 30.10[3.28; 276.42]-3 -NAKasradze, 2017 1 All studiesAll studies 1.88[0.79; 4.50]2018,42576%NAStraub (Lamotrigine) (Epilepsy), 2026 Bjørk (Controls unexposed, sick), 2022 Kasradze, 2017 Rihtman, 2013 Cummings, 2011 50.2100.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.14.11.5060.000Straub (Lamotrigine) (Epilepsy), 2026Bjørk (Controls unexposed, sick), 2022Kasradze, 2017Rihtman, 2013Cummings, 2011

Asymetry test p-value = 0.1897 (by Egger's regression)

slope=-0.6660 (0.5907); intercept=2.5634 (1.5171); t=1.6896; p=0.1897

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 12723

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.91[0.78; 4.65]16,4085,15265%NABjørk (Controls unexposed, NOS), 2022 Kasradze, 2017 Rihtman, 2013 Cummings, 2011 4 unexposed, sick controlsunexposed, sick controls 1.29[0.39; 4.23]1988,34686%NAStraub (Lamotrigine) (Epilepsy), 2026 Bjørk (Controls unexposed, sick), 2022 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Peron (Epilepsy) (Cognitive developmental del ...Peron (Epilepsy) (Cognitive developmental delay (3-6 years old)) 3.39[0.56; 20.57]68%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT3 metaPregmetaPreg 1.88[0.79; 4.50]76%8,425----Straub (Lamotrigine) (Epilepsy), 2026 Bjørk (Controls unexposed, sick), 2022 Kasradze, 2017 Rihtman, 2013 Cummings, 2011 50.510.01.0