Valproate (All indications)

Caesarean

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.
S9283
R32206
Artama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 Caesarean section during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 0.96 [0.62;1.47] C
excluded (control group)
126/706   32/173 158 706
ref
S9284
R32218
Artama (Valproate) (Controls unexposed, disease free), 2013 Caesarean section during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: Yes 1.16 [0.96;1.42]
excluded (control group)
126/706   114,791/721,948 114,917 706
ref
S9285
R32230
Artama (Valproate) (Controls unexposed, sick), 2013 Caesarean section during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes 0.93 [0.73;1.18] 126/706   331/1,800 457 706
ref
S9450
R33184
Rihtman (Valproate) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2013 Cesarean section at least 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No Controls: epilepsy indication 1.80 [0.53;6.08] C
excluded (control group)
7/29   6/40 13 29
ref
S9451
R33219
Rihtman (Valproate) (Controls unexposed, NOS) (Mixed indications), 2013 Cesarean section at least 1st trimester excluded prospective cohort unexposed (general population or NOS) Adjustment: No 3.74 [0.99;14.12] C
excluded (exposition period)
7/29   4/51 11 29
ref
S9432
R33123
Borthen (Valproate) (Controls exposed to Lamotrigine, sick), 2010 Caesarean during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 0.89 [0.55;1.45] C
excluded (control group)
37/215   44/233 81 215
ref
S9434
R33131
Borthen (Valproate) (Controls unexposed, disease free), 2010 Caesarean during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: Yes 1.70 [1.20;2.40]
excluded (control group)
37/215   51,806/362,302 51,843 215
ref
S9436
R33139
Borthen (Valproate) (Controls unexposed, sick), 2010 Caesarean during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No 0.94 [0.65;1.37] C 37/215   337/1,863 374 215
ref
S9300
R32376
Endo (Valproate) (Controls unexposed, disease free), 2004 Cesarean section at least 1st trimester retrospective cohort unexposed, disease free excluded Adjustment: No 0.87 [0.05;16.27] C
excluded (control group)
0/5   74/656 74 5
ref
S9301
R32391
Endo (Valproate) (Controls unexposed, sick), 2004 Cesarean section throughout pregnancy retrospective cohort unexposed, sick Adjustment: No 0.11 [0.00;14.76] C 0/5   0/1 0 5
ref
S9308
R32419
Jäger-Roman (Valproate), 1986 Caesarean section at least 1st trimester excluded prospective cohort unexposed (general population or NOS) Adjustment: No 5.40 [1.38;21.12] C
excluded (exposition period)
4/14   8/116 12 14
ref
Total 3 studies 0.93 [0.76;1.14] 831 926
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 Artama (Valproate) (Controls unexposed, sick), 2013Artama, 2013 1 0.93[0.73; 1.18]45770671%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Borthen (Valproate) (Controls unexposed, sick), 2010Borthen, 2010 2 0.94[0.65; 1.37]37421529%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Endo (Valproate) (Controls unexposed, sick), 2004Endo, 2004 3 0.11[0.00; 14.76]050%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (3 studies) I2 = 0% 0.93[0.76; 1.14]8319260.02.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Valproate) (Controls unexposed, sick; 2: Valproate) (Controls unexposed, sick; 3: Valproate) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.93[0.76; 1.14]8319260%NAArtama (Valproate) (Controls unexposed, sick), 2013 Borthen (Valproate) (Controls unexposed, sick), 2010 Endo (Valproate) (Controls unexposed, sick), 2004 3 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 0.93[0.76; 1.14]8319260%NAArtama (Valproate) (Controls unexposed, sick), 2013 Borthen (Valproate) (Controls unexposed, sick), 2010 Endo (Valproate) (Controls unexposed, sick), 2004 3 Tags Adjustment   - No  - No 0.93[0.64; 1.35]3742200%NABorthen (Valproate) (Controls unexposed, sick), 2010 Endo (Valproate) (Controls unexposed, sick), 2004 2   - Yes  - Yes 0.93[0.73; 1.18]457706 -NAArtama (Valproate) (Controls unexposed, sick), 2013 1 All studiesAll studies 0.93[0.76; 1.14]8319260%NAArtama (Valproate) (Controls unexposed, sick), 2013 Borthen (Valproate) (Controls unexposed, sick), 2010 Endo (Valproate) (Controls unexposed, sick), 2004 30.010.01.0

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 9300, 9432, 9434, 9283, 9284, 9450

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.37[0.94; 1.98]166,76092172%NAArtama (Valproate) (Controls unexposed, disease free), 2013 Borthen (Valproate) (Controls unexposed, disease free), 2010 2 unexposed, sick controlsunexposed, sick controls 0.93[0.76; 1.14]8319260%NAArtama (Valproate) (Controls unexposed, sick), 2013 Borthen (Valproate) (Controls unexposed, sick), 2010 Endo (Valproate) (Controls unexposed, sick), 2004 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.93[0.67; 1.28]2399210%NAArtama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 Borthen (Valproate) (Controls exposed to Lamotrigine, sick), 2010 20.510.01.0