Lamotrigine (All indications)

Cognitive developmental disorders/delay (> 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.
S12727
R53704
Bjørk (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2022 Diagnosis of intellectual disability (ID): mild ID (F70), moderate ID (F71), severe ID (F72), and profound ID (F73) (between 6.1 and 7.9 years old) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: Yes 1.34 [0.92;1.95]
excluded (control group)
27/7,950   16,384/4,463,879 16,411 7,950
ref
S12728
R53705
Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Diagnosis of intellectual disability (ID): mild ID (F70), moderate ID (F71), severe ID (F72), and profound ID (F73) (between 6.1 and 7.9 years old) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No Controls: epilepsy indication 0.53 [0.35;0.80] C 27/7,950   139/21,634 166 7,950
ref
S8941
R53702
Cohen-Israel (Lamotrigine), 2018 Developmental delay (a majority between 6-12 years old) 1st trimester retrospective cohort unexposed, disease free Adjustment: No Matched 0.57 [0.26;1.26] C 12/83   19/83 31 83
ref
S8929
R53700
Baker (Lamotrigine) (Controls unexposed, disease free), 2015 Mean child Full scale IQ - Differential ability scales (DAS) (age mean >6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No extrapolated (cont. endpoint) 1.84 [0.91;3.72]
excluded (control group)
-/29   -/210 - 29
ref
S8930
R53701
Baker (Lamotrigine) (Controls unexposed, sick), 2015 Mean child Full scale IQ - Differential ability scales (DAS) (age mean >6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No extrapolated (cont. endpoint) 1.16 [0.44;3.07] -/29   -/25 - 29
ref
S8945
R53703
Gopinath (Lamotrigine), 2015 Full Scale IQ < 86 (Wechsler Intelligence Scale for Children (WISC-IV)) (at 10–12 years of age) during pregnancy (anytime or not specified) retrospective cohort (registry) unexposed, sick Adjustment: No 0.39 [0.01;22.88] C 0/1   11/16 11 1
ref
Total 4 studies 0.59 [0.42;0.83] 208 8,063
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 Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022Bjørk, 2022 1 0.53[0.35; 0.80]1667,95069%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Cohen-Israel (Lamotrigine), 2018Cohen-Israel, 2018 2 0.57[0.26; 1.26]318318%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Baker (Lamotrigine) (Controls unexposed, sick), 2015Baker, 2015 3 1.16[0.44; 3.07]-2912%ROB confusion: unclearROB selection: lowROB classification: moderateROB missing: moderateROB mesure: lowROB reporting: moderate Gopinath (Lamotrigine), 2015Gopinath, 2015 4 0.39[0.01; 22.88]1111%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 0.59[0.42; 0.83]2088,0630.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

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

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.59[0.42; 0.83]2088,0630%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Cohen-Israel (Lamotrigine), 2018 Baker (Lamotrigine) (Controls unexposed, sick), 2015 Gopinath (Lamotrigine), 2015 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 0.57[0.26; 1.26]3183 -NACohen-Israel (Lamotrigine), 2018 1 unexposed, sickunexposed, sick 0.62[0.39; 0.98]1777,9809%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Baker (Lamotrigine) (Controls unexposed, sick), 2015 Gopinath (Lamotrigine), 2015 3 Tags Adjustment   - No  - No 0.59[0.42; 0.83]2088,0630%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Cohen-Israel (Lamotrigine), 2018 Baker (Lamotrigine) (Controls unexposed, sick), 2015 Gopinath (Lamotrigine), 2015 4 Controls   - epilepsy indication  - epilepsy indication 0.53[0.35; 0.80]1667,950 -NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 1 extrapolated (cont. endpoint)extrapolated (cont. endpoint) 1.16[0.44; 3.06]-29 -NABaker (Lamotrigine) (Controls unexposed, sick), 2015 1 MatchedMatched 0.57[0.26; 1.26]3183 -NACohen-Israel (Lamotrigine), 2018 1 All studiesAll studies 0.59[0.42; 0.83]2088,0630%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Cohen-Israel (Lamotrigine), 2018 Baker (Lamotrigine) (Controls unexposed, sick), 2015 Gopinath (Lamotrigine), 2015 40.15.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.94.42.4910.000Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022Cohen-Israel (Lamotrigine), 2018Baker (Lamotrigine) (Controls unexposed, sick), 2015Gopinath (Lamotrigine), 2015

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 8929, 12727

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.18[0.67; 2.06]16,4428,06260%NABjørk (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2022 Cohen-Israel (Lamotrigine), 2018 Baker (Lamotrigine) (Controls unexposed, disease free), 2015 3 unexposed, sick controlsunexposed, sick controls 0.62[0.39; 0.98]1777,9809%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Baker (Lamotrigine) (Controls unexposed, sick), 2015 Gopinath (Lamotrigine), 2015 30.510.01.0