Valproate (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.
S9314
R32447		 Bank (Valproate) (Mixed indications), 2017 Apgar < 7 at 1 minute during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 1.22 [0.05;28.93] C 0/6   2/36 2 6
ref
S9283
R32204		 Artama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 1-min Apgar <7 3rd trimester population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 1.31 [0.62;2.73] C
excluded (control group) 		45/600   9/154 54 600
ref
S9284
R32216		 Artama (Valproate) (Controls unexposed, disease free), 2013 1-min Apgar <7 3rd trimester population based cohort retrospective unexposed, disease free excluded Adjustment: Yes 1.76 [1.29;2.39]
excluded (control group) 		45/600   27,939/689,482 27,984 600
ref
S9285
R32228		 Artama (Valproate) (Controls unexposed, sick), 2013 1-min Apgar <7 3rd trimester population based cohort retrospective unexposed, sick Adjustment: Yes 1.78 [1.20;2.66] 45/600   69/1,708 114 600
ref
S9323
R32491		 Pennell (Valproate), 2012 Apgar score (at 1 minute < 7) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 6.78 [2.12;21.73] C 14/62   4/97 18 62
ref
S9300
R32384		 Endo (Valproate) (Controls unexposed, disease free), 2004 Apgar score (<8 at 1min) at least 1st trimester retrospective cohort unexposed, disease free excluded Adjustment: No 0.54 [0.03;10.27] C
excluded (control group) 		0/5   47/280 47 5
ref
S9301
R32399		 Endo (Valproate) (Controls unexposed, sick), 2004 Apgar score (<8 at 1min) throughout pregnancy retrospective cohort unexposed, sick Adjustment: No 0.11 [0.00;14.76] C 0/5   0/1 0 5
ref
Total 4 studies 2.39 [0.84;6.81] 134 673
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 (Valproate) (Mixed indications), 2017Bank, 2017 1 1.22[0.05; 28.93]269%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Artama (Valproate) (Controls unexposed, sick), 2013Artama, 2013 2 1.78[1.20; 2.66]11460053%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Pennell (Valproate), 2012Pennell, 2012 3 6.78[2.12; 21.73]186234%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Endo (Valproate) (Controls unexposed, sick), 2004Endo, 2004 4 0.11[0.00; 14.76]054%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (4 studies) I2 = 50% 2.39[0.84; 6.81]1346730.020.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

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

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.39[0.84; 6.81]13467350%NABank (Valproate) (Mixed indications), 2017 Artama (Valproate) (Controls unexposed, sick), 2013 Pennell (Valproate), 2012 Endo (Valproate) (Controls unexposed, sick), 2004 4 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 1.36[0.27; 6.84]11460519%NAArtama (Valproate) (Controls unexposed, sick), 2013 Endo (Valproate) (Controls unexposed, sick), 2004 2 exposed to other treatment, sickexposed to other treatment, sick 5.53[1.85; 16.49]20680%NABank (Valproate) (Mixed indications), 2017 Pennell (Valproate), 2012 2 Tags Adjustment   - No  - No 2.45[0.33; 18.31]207340%NABank (Valproate) (Mixed indications), 2017 Pennell (Valproate), 2012 Endo (Valproate) (Controls unexposed, sick), 2004 3   - Yes  - Yes 1.78[1.20; 2.65]114600 -NAArtama (Valproate) (Controls unexposed, sick), 2013 1 All studiesAll studies 2.39[0.84; 6.81]13467350%NABank (Valproate) (Mixed indications), 2017 Artama (Valproate) (Controls unexposed, sick), 2013 Pennell (Valproate), 2012 Endo (Valproate) (Controls unexposed, sick), 2004 40.020.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-5.96.72.9930.000Bank (Valproate) (Mixed indications), 2017Artama (Valproate) (Controls unexposed, sick), 2013Pennell (Valproate), 2012Endo (Valproate) (Controls unexposed, sick), 2004

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 9300, 9283, 9284

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.76[1.29; 2.40]27,984600 -NAArtama (Valproate) (Controls unexposed, disease free), 2013 1 unexposed, sick controlsunexposed, sick controls 1.36[0.27; 6.84]11460519%NAArtama (Valproate) (Controls unexposed, sick), 2013 Endo (Valproate) (Controls unexposed, sick), 2004 2 exposed to other treatment, sick controlsexposed to other treatment, sick controls 2.46[0.67; 9.04]7466864%NABank (Valproate) (Mixed indications), 2017 Artama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 Pennell (Valproate), 2012 30.510.01.0