Phenytoin (All indications)

Low Apgar score (< 7) (at 1 min)

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.
S9272
R32152		 Bank (Phenytoin) (Mixed indications), 2017 Apgar < 7 at 1 minute during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 2.68 [0.10;72.45] C 0/3   2/36 2 3
ref
S9187
R31772		 Artama (Phenytoin) (Controls exposed to Lamotrigine, sick), 2013 1-min Apgar <7 3rd trimester population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 0.37 [0.02;6.62] C
excluded (control group) 		0/21   9/154 9 21
ref
S9188
R31784		 Artama (Phenytoin) (Controls unexposed, disease free), 2013 1-min Apgar <7 3rd trimester population based cohort retrospective unexposed, disease free excluded Adjustment: No 0.58 [0.03;9.55] C
excluded (control group) 		0/21   27,939/689,482 27,939 21
ref
S9190
R31808		 Artama (Phenytoin) (Controls unexposed, sick), 2013 1-min Apgar <7 3rd trimester population based cohort retrospective unexposed, sick Adjustment: No 0.58 [0.03;9.61] C 0/21   69/1,708 69 21
ref
S9216
R31980		 Pennell (Phenytoin), 2012 Apgar score (at 1 minute < 7) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 5.41 [1.60;18.22] C 10/53   4/97 14 53
ref
Total 3 studies 3.53 [1.15;10.87] 85 77
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 Bank (Phenytoin) (Mixed indications), 2017Bank, 2017 1 2.68[0.10; 72.45]2311%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Artama (Phenytoin) (Controls unexposed, sick), 2013Artama, 2013 2 0.58[0.03; 9.61]692115%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Pennell (Phenytoin), 2012Pennell, 2012 3 5.41[1.60; 18.22]145373%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (3 studies) I2 = 4% 3.53[1.15; 10.87]85770.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

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

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 3.53[1.15; 10.87]85774%NABank (Phenytoin) (Mixed indications), 2017 Artama (Phenytoin) (Controls unexposed, sick), 2013 Pennell (Phenytoin), 2012 3 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 0.58[0.03; 9.61]6921 -NAArtama (Phenytoin) (Controls unexposed, sick), 2013 1 exposed to other treatment, sickexposed to other treatment, sick 4.97[1.59; 15.54]16560%NABank (Phenytoin) (Mixed indications), 2017 Pennell (Phenytoin), 2012 2 Tags Adjustment   - No  - No 3.53[1.15; 10.87]85774%NABank (Phenytoin) (Mixed indications), 2017 Artama (Phenytoin) (Controls unexposed, sick), 2013 Pennell (Phenytoin), 2012 3 All studiesAll studies 3.53[1.15; 10.87]85774%NABank (Phenytoin) (Mixed indications), 2017 Artama (Phenytoin) (Controls unexposed, sick), 2013 Pennell (Phenytoin), 2012 30.220.01.0

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 9187, 9188

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 0.58[0.03; 9.55]27,93921 -NAArtama (Phenytoin) (Controls unexposed, disease free), 2013 1 unexposed, sick controlsunexposed, sick controls 0.58[0.03; 9.61]6921 -NAArtama (Phenytoin) (Controls unexposed, sick), 2013 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 2.65[0.57; 12.31]257730%NABank (Phenytoin) (Mixed indications), 2017 Artama (Phenytoin) (Controls exposed to Lamotrigine, sick), 2013 Pennell (Phenytoin), 2012 30.510.01.0