Carbamazepine (All indications)

ADHD (Attention deficit hyperactivity disorder): Risk

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.
S9723
R34622		 Huber-Mollema (Carbamazepine), 2019 ADHD total (Social Emotional Questionnaire) (Completed by mothers) Clinical cutoff throughout pregnancy prospective cohort exposed to other treatment, sick Adjustment: No 0.47 [0.05;4.16] C 1/36   5/87 6 36
ref
S9734
R34679		 Richards (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Indications NOS), 2019 The Strengths and Difficulties Questionnaire - parent-completed (SDQP) Hyperactivity ≥7 (at 4 years old) during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: Yes 0.86 [0.45;1.67]
excluded (control group) 		17/201   13/149 30 201
ref
S9735
R34689		 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 The Strengths and Difficulties Questionnaire - parent-completed (SDQP) Hyperactivity ≥7 (at 4 years old) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes 1.83 [1.11;3.02] 17/201   11,841/286,966 11,858 201
ref
S9711
R34564		 Cohen (Carbamazepine), 2013 Children with either ADHD inattentive OR combined types > 1 SD (from the Attention Problems and Hyperactivity scales of the BASC) (Parent) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 1.61 [0.56;4.69] C 9/52   7/61 16 52
ref
S9743
R34757		 Veiby (Carbamazepine) (Controls exposed to Lamotrigine, sick) b, 2013 ADHD symptoms ≥ 2SD (at 36 months) (Specific checklist) (Parent-reported) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 0.94 [0.15;6.00] C
excluded (control group) 		2/31   3/44 5 31
ref
S9745
R34776		 Veiby (Carbamazepine) (Controls unexposed, disease free) b, 2013 ADHD symptoms ≥ 2SD (at 36 months) (Specific checklist) (Parent-reported) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 2.00 [0.50;8.60]
excluded (control group) 		2/31   1,743/43,571 1,745 31
ref
S9746
R34790		 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 ADHD symptoms ≥ 2SD (at 36 months) (Specific checklist) (Parent-reported) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 2.59 [0.45;14.78] C 2/31   4/154 6 31
ref
S9747
R34807		 Viinikainen (Carbamazepine) b, 2006 Conners' Teacher Rating Scale Global Index scores >1 SD throughout pregnancy prospective cohort unexposed, sick Adjustment: No 0.15 [0.01;3.50] C 0/12   2/11 2 12
ref
Total 5 studies 1.66 [1.08;2.54] 11,888 332
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 Huber-Mollema (Carbamazepine), 2019Huber-Mollema, 2019 1 0.47[0.05; 4.16]6364%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019Richards, 2019 2 1.83[1.11; 3.02]11,85820172%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Cohen (Carbamazepine), 2013Cohen, 2013 3 1.61[0.56; 4.69]165216%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: criticalROB mesure: lowROB reporting: low Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013Veiby, 2013 4 2.59[0.45; 14.78]6316%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Viinikainen (Carbamazepine) b, 2006Viinikainen, 2006 5 0.15[0.01; 3.50]2122%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: moderateROB mesure: lowROB reporting: moderate Total (5 studies) I2 = 0% 1.66[1.08; 2.54]11,8883320.010.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Carbamazepine; 2: Carbamazepine) (Controls unexposed, NOS) (Indications NOS; 3: Carbamazepine; 4: Carbamazepine) (Controls unexposed, sick) ; 5: Carbamazepine) ;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.66[1.08; 2.54]11,8883320%NAHuber-Mollema (Carbamazepine), 2019 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.83[1.11; 3.02]11,858201 -NARichards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 1 unexposed, sickunexposed, sick 0.85[0.06; 13.08]84359%NAVeiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 2 exposed to other treatment, sickexposed to other treatment, sick 1.27[0.49; 3.32]22880%NAHuber-Mollema (Carbamazepine), 2019 Cohen (Carbamazepine), 2013 2 Tags Adjustment   - No  - No 1.23[0.49; 3.05]3013112%NAHuber-Mollema (Carbamazepine), 2019 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 4   - Yes  - Yes 1.83[1.11; 3.02]11,858201 -NARichards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 1 All studiesAll studies 1.66[1.08; 2.54]11,8883320%NAHuber-Mollema (Carbamazepine), 2019 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 50.010.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.84.31.9370.000Huber-Mollema (Carbamazepine), 2019Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019Cohen (Carbamazepine), 2013Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013Viinikainen (Carbamazepine) b, 2006

Asymetry test p-value = 0.1822 (by Egger's regression)

slope=0.9374 (0.3047); intercept=-1.0841 (0.6270); t=1.7290; p=0.1822

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9743, 9745, 9734

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.85[1.15; 2.96]13,6032320%NARichards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Veiby (Carbamazepine) (Controls unexposed, disease free) b, 2013 2 unexposed, sick controlsunexposed, sick controls 0.85[0.06; 13.08]84359%NAVeiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 2 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.97[0.58; 1.63]573200%NAHuber-Mollema (Carbamazepine), 2019 Richards (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Indications NOS), 2019 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls exposed to Lamotrigine, sick) b, 2013 40.510.01.0