Carbamazepine (All indications)

Microcephaly / Small head circumference for gestational age

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.
S10176
R37249
Blotière (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2019 Microcephaly (until 24 months of age, identifiable by: Q02; brain MRI; according to the EUROCAT definition) 1st trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No 5.86 [0.37;93.89] C
excluded (control group)
1/512   1/2,997 2 512
ref
S9766
R34899
Blotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019 Microcephaly (until 24 months of age, identifiable by: Q02; brain MRI; according to the EUROCAT definition) 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No 7.80 [0.20;44.10] 1/512   438/1,875,733 439 512
ref
S9640
R34296
Pennell (Carbamazepine), 2012 Microcephaly at birth (head circumference < 3 percentile) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 2.51 [0.90;7.05] C 13/69   6/71 19 69
ref
S9669
R34424
Kini (Carbamazepine) (Controls unexposed, sick), 2006 Head circumference in children aged between 6 months and 16 years <3rd centile during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 0.42 [0.08;2.21] C 2/94   5/101 7 94
ref
S9621
R34202
Holmes (Carbamazepine) (Controls unexposed, disease free), 2001 Microcephaly at birth (Head circumference more than 2 SD below the mean value for the same race, sex and gestational age) during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free excluded Adjustment: No 2.31 [0.48;11.18] C
excluded (control group)
2/56   8/508 10 56
ref
S9622
R34211
Holmes (Carbamazepine) (Controls unexposed, sick), 2001 Microcephaly at birth (Head circumference more than 2 SD below the mean value for the same race, sex and gestational age) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 1.74 [0.24;12.71] C 2/56   2/96 4 56
ref
S9689
R34474
Battino (Carbamazepine), 1999 Small head circumferences (at birth < 10th percentile) throughout pregnancy prospective cohort unexposed, sick Adjustment: Yes 0.50 [0.11;2.00] 7/128   3/30 10 128
ref
S9690
R34475
Díaz-Romero (Carbamazepine), 1999 Head circumference <2 SD at birth (measured by a physician and correlated with sex and with gestational age) during pregnancy (anytime or not specified) cohort unexposed, sick Adjustment: No 0.29 [0.01;16.12] C 0/26   0/8 0 26
ref
S9769
R34930
Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997 Microcephaly at unknown age (head circumference ≤ 2 SD from the mean of children of the same age and sex) at least 1st trimester prospective cohort unexposed, sick Adjustment: No Controls: epilepsy indication 1.95 [0.09;41.57] C 3/34   0/9 3 34
ref
Total 7 studies 1.26 [0.58;2.73] 482 919
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 Blotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019Blotière, 2019 1 7.80[0.20; 44.10]4395127%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Pennell (Carbamazepine), 2012Pennell, 2012 2 2.51[0.90; 7.05]196932%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Kini (Carbamazepine) (Controls unexposed, sick), 2006Kini, 2006 3 0.42[0.08; 2.21]79417%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: unclearROB mesure: moderateROB reporting: moderate Holmes (Carbamazepine) (Controls unexposed, sick), 2001Holmes, 2001 4 1.74[0.24; 12.71]45613%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Battino (Carbamazepine), 1999Battino, 1999 5 0.50[0.11; 2.00]1012821%ROB confusion: moderateROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Díaz-Romero (Carbamazepine), 1999Díaz-Romero, 1999 6 0.29[0.01; 16.12]0264%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997Nulman, 1997 7 1.95[0.09; 41.57]3346%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (7 studies) I2 = 19% 1.26[0.58; 2.73]4829190.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Carbamazepine) (Controls unexposed NOS) (Mixed indications; 2: Carbamazepine; 3: Carbamazepine) (Controls unexposed, sick; 4: Carbamazepine) (Controls unexposed, sick; 5: Carbamazepine; 6: Carbamazepine; 7: Carbamazepine) (Controls unexposed, sick) (Mixed indications;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.26[0.58; 2.73]48291919%NABlotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019 Pennell (Carbamazepine), 2012 Kini (Carbamazepine) (Controls unexposed, sick), 2006 Holmes (Carbamazepine) (Controls unexposed, sick), 2001 Battino (Carbamazepine), 1999 Díaz-Romero (Carbamazepine), 1999 Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997 7 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 7.80[0.53; 115.82]439512 -NABlotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019 1 unexposed, sickunexposed, sick 0.67[0.27; 1.63]243380%NAKini (Carbamazepine) (Controls unexposed, sick), 2006 Holmes (Carbamazepine) (Controls unexposed, sick), 2001 Battino (Carbamazepine), 1999 Díaz-Romero (Carbamazepine), 1999 Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997 5 exposed to other treatment, sickexposed to other treatment, sick 2.51[0.90; 7.05]1969 -NAPennell (Carbamazepine), 2012 1 Tags Adjustment   - No  - No 1.65[0.76; 3.59]4727915%NABlotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019 Pennell (Carbamazepine), 2012 Kini (Carbamazepine) (Controls unexposed, sick), 2006 Holmes (Carbamazepine) (Controls unexposed, sick), 2001 Díaz-Romero (Carbamazepine), 1999 Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997 6   - Yes  - Yes 0.50[0.12; 2.13]10128 -NABattino (Carbamazepine), 1999 1 Controls   - epilepsy indication  - epilepsy indication 1.95[0.09; 41.57]334 -NANulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997 1 All studiesAll studies 1.26[0.58; 2.73]48291919%NABlotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019 Pennell (Carbamazepine), 2012 Kini (Carbamazepine) (Controls unexposed, sick), 2006 Holmes (Carbamazepine) (Controls unexposed, sick), 2001 Battino (Carbamazepine), 1999 Díaz-Romero (Carbamazepine), 1999 Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997 70.120.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.85.02.4510.000Blotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019Pennell (Carbamazepine), 2012Kini (Carbamazepine) (Controls unexposed, sick), 2006Holmes (Carbamazepine) (Controls unexposed, sick), 2001Battino (Carbamazepine), 1999Díaz-Romero (Carbamazepine), 1999Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997

Asymetry test p-value = 0.8019 (by Egger's regression)

slope=0.5199 (1.0139); intercept=-0.3037 (1.1481); t=0.2645; p=0.8019

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9621, 10176

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 3.15[0.81; 12.28]4495680%NABlotière (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2019 Holmes (Carbamazepine) (Controls unexposed, disease free), 2001 2 unexposed, sick controlsunexposed, sick controls 0.67[0.27; 1.63]243380%NAKini (Carbamazepine) (Controls unexposed, sick), 2006 Holmes (Carbamazepine) (Controls unexposed, sick), 2001 Battino (Carbamazepine), 1999 Díaz-Romero (Carbamazepine), 1999 Nulman (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 1997 5 exposed to other treatment, sick controlsexposed to other treatment, sick controls 2.79[1.06; 7.33]215810%NABlotière (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2019 Pennell (Carbamazepine), 2012 20.510.01.0