Lamotrigine (All indications)

Small for gestational age (weight)

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.
S15218
R62393
Bromley (Lamotrigine) (Epilepsy), 2023 Small for gestation (calculated using gender-specific scales) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 0.72 [0.31;1.65] C 13/106   13/80 26 106
ref
S12547
R47237
Dreier (Lamotrigine), 2021 Small for gestational age (birth weight below the 10th percentile for GA, sex and country) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes 0.97 [0.87;1.08] -/4,679   -/- - 4,679
ref
S12611
R47524
Van Marter (Lamotrigine) (Controls unexposed, disease free), 2021 Small for gestational age (weight for gestational age <10th percentile) at least 1st trimester prospective cohort unexposed, disease free excluded Adjustment: No 0.10 [0.01;0.79] C
excluded (control group)
1/106   9/102 10 106
ref
S12613
R47536
Van Marter (Lamotrigine) (Controls unexposed, sick), 2021 Small for gestational age (weight for gestational age <10th percentile) at least 1st trimester prospective cohort unexposed, sick Adjustment: No 0.39 [0.02;10.00] C 1/106   0/14 1 106
ref
S8904
R30081
Aydin (Lamotrigine), 2020 Small for gestational age (birth weight) throughout pregnancy retrospective cohort unexposed, sick Adjustment: No 3.31 [0.06;183.69] C 0/7   0/22 0 7
ref
S8978
R30434
Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Small for gestational age (weight) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No 1.04 [0.92;1.17] C 284/2,813   167,016/1,707,707 167,300 2,813
ref
S8963
R30354
Cohen (Lamotrigine) (Mixed indications), 2019 Small for gestational age (ICD-9 656.5, 764.0, 764.1, 764.9) early pregnancy retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes 0.86 [0.69;1.05] 106/2,682   41,653/1,440,631 41,759 2,682
ref
S8974
R30419
Hernández-Díaz (Lamotrigine) (Mixed indications), 2014 Small for gestational age (SGA) (<10th percentile) throughout pregnancy prospective cohort unexposed, disease free Adjustment: No 1.37 [0.86;2.18] C 107/1,581   23/457 130 1,581
ref
S8975
R30421
Kilic (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2014 Small for gestational age (birth weight <10% percentile for the gestational birth week) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: Yes 0.80 [0.70;1.10]
excluded (control group)
78/876   65,118/673,844 65,196 876
ref
S8976
R30424
Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014 Small for gestational age (birth weight <10% percentile for the gestational birth week) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No Controls: epilepsy indication 0.77 [0.60;0.99] C 78/876   594/5,275 672 876
ref
S8902
R30064
Artama (Lamotrigine) (Controls unexposed, disease free), 2013 Small for gestational age (weight) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: Yes 0.49 [0.12;1.97]
excluded (control group)
2/173   14,079/719,509 14,081 173
ref
S8903
R30076
Artama (Lamotrigine) (Controls unexposed, sick), 2013 Small for gestational age (weight) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes 0.42 [0.10;1.81] 2/173   42/1,793 44 173
ref
S8953
R30313
Veiby (Lamotrigine) (Controls unexposed, disease free) b, 2013 Small for gestational age (SGA) birth weight during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: Yes 0.60 [0.20;1.40]
excluded (control group)
5/103   8,017/106,899 8,022 103
ref
S8954
R30327
Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013 Small for gestational age (SGA) birth weight during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 0.58 [0.22;1.54] C 5/103   31/386 36 103
ref
Total 10 studies 0.94 [0.86;1.04] 209,968 13,126
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 Bromley (Lamotrigine) (Epilepsy), 2023Bromley, 2023 1 0.72[0.31; 1.65]261061%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: low Dreier (Lamotrigine), 2021Dreier, 2021 2 0.97[0.87; 1.08]-4,67934%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Van Marter (Lamotrigine) (Controls unexposed, sick), 2021Van Marter, 2021 3 0.39[0.02; 10.00]11060%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: low Aydin (Lamotrigine), 2020Aydin, 2020 4 3.31[0.06; 183.69]070%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020Coste, 2020 5 1.04[0.92; 1.17]167,3002,81330%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: moderateROB mesure: moderateROB reporting: moderate Cohen (Lamotrigine) (Mixed indications), 2019Cohen, 2019 6 0.86[0.69; 1.05]41,7592,68216%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Hernández-Díaz (Lamotrigine) (Mixed indications), 2014Hernández-Díaz, 2014 7 1.37[0.86; 2.18]1301,5814%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014Kilic, 2014 8 0.77[0.60; 0.99]67287612%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Artama (Lamotrigine) (Controls unexposed, sick), 2013Artama, 2013 9 0.42[0.10; 1.81]441730%ROB confusion: moderateROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013Veiby, 2013 10 0.58[0.22; 1.54]361031%ROB confusion: seriousROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Total (10 studies) I2 = 20% 0.94[0.86; 1.04]209,96813,1260.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Lamotrigine) (Epilepsy; 2: Lamotrigine; 3: Lamotrigine) (Controls unexposed, sick; 4: Lamotrigine; 5: Lamotrigine) (Controls unexposed NOS) (Mixed indications; 6: Lamotrigine) (Mixed indications; 7: Lamotrigine) (Mixed indications; 8: Lamotrigine) (Controls unexposed, sick) (Mixed indications; 9: Lamotrigine) (Controls unexposed, sick; 10: Lamotrigine) (Controls unexposed, sick) ;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.94[0.86; 1.04]209,96813,12620%NABromley (Lamotrigine) (Epilepsy), 2023 Dreier (Lamotrigine), 2021 Van Marter (Lamotrigine) (Controls unexposed, sick), 2021 Aydin (Lamotrigine), 2020 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Cohen (Lamotrigine) (Mixed indications), 2019 Hernández-Díaz (Lamotrigine) (Mixed indications), 2014 Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Lamotrigine) (Controls unexposed, sick), 2013 Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013 10 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.00[0.84; 1.21]209,1897,07651%NACoste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Cohen (Lamotrigine) (Mixed indications), 2019 Hernández-Díaz (Lamotrigine) (Mixed indications), 2014 3 unexposed, sickunexposed, sick 0.92[0.84; 1.02]7796,0500%NABromley (Lamotrigine) (Epilepsy), 2023 Dreier (Lamotrigine), 2021 Van Marter (Lamotrigine) (Controls unexposed, sick), 2021 Aydin (Lamotrigine), 2020 Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Lamotrigine) (Controls unexposed, sick), 2013 Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013 7 Tags Adjustment   - No  - No 0.94[0.77; 1.15]168,1655,59231%NABromley (Lamotrigine) (Epilepsy), 2023 Van Marter (Lamotrigine) (Controls unexposed, sick), 2021 Aydin (Lamotrigine), 2020 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Hernández-Díaz (Lamotrigine) (Mixed indications), 2014 Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014 Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013 7   - Yes  - Yes 0.94[0.84; 1.05]41,8037,5349%NADreier (Lamotrigine), 2021 Cohen (Lamotrigine) (Mixed indications), 2019 Artama (Lamotrigine) (Controls unexposed, sick), 2013 3 Controls   - epilepsy indication  - epilepsy indication 0.77[0.60; 0.99]672876 -NAKilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014 1 All studiesAll studies 0.94[0.86; 1.04]209,96813,12620%NABromley (Lamotrigine) (Epilepsy), 2023 Dreier (Lamotrigine), 2021 Van Marter (Lamotrigine) (Controls unexposed, sick), 2021 Aydin (Lamotrigine), 2020 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Cohen (Lamotrigine) (Mixed indications), 2019 Hernández-Díaz (Lamotrigine) (Mixed indications), 2014 Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Lamotrigine) (Controls unexposed, sick), 2013 Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013 100.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.84.82.4590.000Bromley (Lamotrigine) (Epilepsy), 2023Dreier (Lamotrigine), 2021Van Marter (Lamotrigine) (Controls unexposed, sick), 2021Aydin (Lamotrigine), 2020Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020Cohen (Lamotrigine) (Mixed indications), 2019Hernández-Díaz (Lamotrigine) (Mixed indications), 2014Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014Artama (Lamotrigine) (Controls unexposed, sick), 2013Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013

Asymetry test p-value = 0.3101 (by Egger's regression)

slope=0.0043 (0.0573); intercept=-0.5420 (0.5002); t=1.0836; p=0.3101

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 8902, 8953, 8975, 12611

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 0.91[0.74; 1.11]296,4988,33456%NAVan Marter (Lamotrigine) (Controls unexposed, disease free), 2021 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Cohen (Lamotrigine) (Mixed indications), 2019 Hernández-Díaz (Lamotrigine) (Mixed indications), 2014 Kilic (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2014 Artama (Lamotrigine) (Controls unexposed, disease free), 2013 Veiby (Lamotrigine) (Controls unexposed, disease free) b, 2013 7 unexposed, sick controlsunexposed, sick controls 0.92[0.84; 1.02]7796,0500%NABromley (Lamotrigine) (Epilepsy), 2023 Dreier (Lamotrigine), 2021 Van Marter (Lamotrigine) (Controls unexposed, sick), 2021 Aydin (Lamotrigine), 2020 Kilic (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Lamotrigine) (Controls unexposed, sick), 2013 Veiby (Lamotrigine) (Controls unexposed, sick) b, 2013 70.510.01.0