Phenytoin (All indications)

Low Apgar score (< 7) (at 5 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
R32153		 Bank (Phenytoin) (Mixed indications), 2017 Apgar < 7 at 5 minutes during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 14.20 [0.23;878.06] C 0/3   0/36 0 3
ref
S9187
R31773		 Artama (Phenytoin) (Controls exposed to Lamotrigine, sick), 2013 5-min Apgar <7 3rd trimester population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 12.24 [0.42;356.65] C
excluded (control group) 		0/2   3/132 3 2
ref
S9188
R31785		 Artama (Phenytoin) (Controls unexposed, disease free), 2013 5-min Apgar <7 3rd trimester population based cohort retrospective unexposed, disease free excluded Adjustment: No 29.43 [1.20;722.58] C
excluded (control group) 		0/2   3,014/269,151 3,014 2
ref
S9190
R31809		 Artama (Phenytoin) (Controls unexposed, sick), 2013 5-min Apgar <7 3rd trimester population based cohort retrospective unexposed, sick Adjustment: No 61.76 [2.13;1793.52] C 0/2   3/652 3 2
ref
S9216
R31981		 Pennell (Phenytoin), 2012 Apgar score (at 5 minutes < 7) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 9.55 [0.45;202.85] C 2/53   0/97 2 53
ref
Total 3 studies 20.01 [2.75;145.51] 5 58
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 14.20[0.23; 878.06]0323%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Artama (Phenytoin) (Controls unexposed, sick), 2013Artama, 2013 2 61.76[2.13; 1793.52]3235%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Pennell (Phenytoin), 2012Pennell, 2012 3 9.55[0.45; 202.85]25342%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (3 studies) I2 = 0% 20.01[2.75; 145.51]5580.9500.01.0ROB: 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 20.01[2.75; 145.51]5580%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 61.76[2.13; 1793.52]32 -NAArtama (Phenytoin) (Controls unexposed, sick), 2013 1 exposed to other treatment, sickexposed to other treatment, sick 10.99[0.94; 128.07]2560%NABank (Phenytoin) (Mixed indications), 2017 Pennell (Phenytoin), 2012 2 Tags Adjustment   - No  - No 20.01[2.75; 145.51]5580%NABank (Phenytoin) (Mixed indications), 2017 Artama (Phenytoin) (Controls unexposed, sick), 2013 Pennell (Phenytoin), 2012 3 All studiesAll studies 20.01[2.75; 145.51]5580%NABank (Phenytoin) (Mixed indications), 2017 Artama (Phenytoin) (Controls unexposed, sick), 2013 Pennell (Phenytoin), 2012 30.51000.01.0

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) Out of scale29.43[1.20; 722.58]3,0142 -NAArtama (Phenytoin) (Controls unexposed, disease free), 2013 1 unexposed, sick controlsunexposed, sick controls Out of scale61.76[2.13; 1793.52]32 -NAArtama (Phenytoin) (Controls unexposed, sick), 2013 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls Out of scale11.41[1.57; 83.04]5580%NABank (Phenytoin) (Mixed indications), 2017 Artama (Phenytoin) (Controls exposed to Lamotrigine, sick), 2013 Pennell (Phenytoin), 2012 30.510.01.0