Carbamazepine (All indications) updated on 04-22-2025

ADHD (Attention deficit hyperactivity disorder): Diagnosis/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.
S17405
R72981
Madley-Dowd_SE (Carbamazepine) (Controls exposed to LTG) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD-8/9/10 codes and/or ADHD medication prescription - Median follow up 15.8 (9.52-21.08) years old during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: Yes Partial overlapping 1.16 [1.02;1.33]
excluded (control group)
257/2,427   243/5,035 500 2,427
ref
S17406
R72985
Madley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD-8/9/10 codes and/or ADHD medication prescription - Median follow up 15.8 (9.52-21.08) years old during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Partial overlapping 1.05 [0.92;1.19] 257/2,427   147,608/2,651,210 147,865 2,427
ref
S17407
R72989
Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sibling) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD-8/9/10 codes and/or ADHD medication prescription - Median follow up 15.8 (9.52-21.08) years old during pregnancy (anytime or not specified) population based cohort retrospective sibling excluded Adjustment: Yes Partial overlapping 0.98 [0.68;1.41]
excluded (control group)
-/-   -/- - -
ref
S17280
R72358
Madley-Dowd_UK (Carbamazepine) (Controls exposed to LTG) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median CBZ 9.17 (5.31-12.54) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: Yes 0.61 [0.35;1.07]
excluded (control group)
13/603   14/939 27 603
ref
S17264
R72359
Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median CBZ 9.17 (5.31-12.54) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes 1.51 [0.87;2.61] 13/603   4,794/514,066 4,807 603
ref
S17272
R72360
Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sibling) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median CBZ 9.17 (5.31-12.54) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) sibling excluded Adjustment: Yes 0.86 [0.26;2.91]
excluded (control group)
-/-   -/- - -
ref
S15231
R63057
Dreier (Carbamazepine) (Epilepsy) (Controls exposed to LTG), 2023 Attention-deficit/hyperactivity disorder (ADHD) - Corresponding ICD-10 F-chapter - Up to 22 years of age during pregnancy (anytime or not specified) population based cohort propective exposed to other treatment, sick excluded Adjustment: No 1.89 [1.41;2.53] C
excluded (control group)
89/2,665   95/5,288 184 2,665
ref
S15235
R63058
Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Attention-deficit/hyperactivity disorder (ADHD) - Corresponding ICD-10 F-chapter - Up to 22 years of age during pregnancy (anytime or not specified) population based cohort propective unexposed, sick Adjustment: Yes 1.05 [0.81;1.37] 89/2,665   528/22,203 617 2,665
ref
S9723
R46370
Huber-Mollema (Carbamazepine), 2019 Diagnosis of ADHD throughout pregnancy prospective cohort exposed to other treatment, sick Adjustment: No 0.95 [0.18;5.12] C 2/37   5/88 7 37
ref
S9734
R46372
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
R46373
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
S9696
R46364
Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 Attention deficit hyperactivity disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 1.82 [0.07;46.28] C
excluded (control group)
1/50   0/30 1 50
ref
S9699
R46365
Bromley (Carbamazepine) (Controls unexposed, disease free), 2013 Attention deficit hyperactivity disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 13.21 [0.53;329.15] C
excluded (control group)
1/50   0/214 1 50
ref
S9702
R46366
Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Attention deficit hyperactivity disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 1.58 [0.06;40.13] C 1/50   0/26 1 50
ref
S9711
R46369
Cohen (Carbamazepine), 2013 Children with either ADHD inattentive OR combined types > 1 SD (from the Attention Problems and Hyperactivity scales of the BASC) (Both Parent and Teacher) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 0.96 [0.22;4.25] C 4/32   4/31 8 32
ref
S9743
R46374
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
R46375
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
R46376
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
R46377
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 9 studies 1.11 [0.98;1.27] 165,171 6,058
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 Madley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_SE, 2024 1 1.05[0.92; 1.19]147,8652,42763%ROB confusion: seriousROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_UK, 2024 2 1.51[0.87; 2.61]4,8076036%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023Dreier, 2023 3 1.05[0.81; 1.37]6172,66522%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Huber-Mollema (Carbamazepine), 2019Huber-Mollema, 2019 4 0.95[0.18; 5.12]7371%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019Richards, 2019 5 1.83[1.11; 3.02]11,8582017%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Bromley (Carbamazepine) (Controls unexposed, sick), 2013Bromley, 2013 6 1.58[0.06; 40.13]1500%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Cohen (Carbamazepine), 2013Cohen, 2013 7 0.96[0.22; 4.25]8321%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: criticalROB mesure: lowROB reporting: low Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013Veiby, 2013 8 2.59[0.45; 14.78]6311%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Viinikainen (Carbamazepine) b, 2006Viinikainen, 2006 9 0.15[0.01; 3.50]2120%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: moderateROB mesure: lowROB reporting: moderate Total (9 studies) I2 = 5% 1.11[0.98; 1.27]165,1716,0580.010.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Carbamazepine) (Controls unexposed, general pop) (Mixed indications; 2: Carbamazepine) (Controls unexposed, general pop) (Mixed indications; 3: Carbamazepine) (Epilepsy) (Controls unexposed, sick; 4: Carbamazepine; 5: Carbamazepine) (Controls unexposed, NOS) (Indications NOS; 6: Carbamazepine) (Controls unexposed, sick; 7: Carbamazepine; 8: Carbamazepine) (Controls unexposed, sick) ; 9: Carbamazepine) ;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.11[0.98; 1.27]165,1716,0585%NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Huber-Mollema (Carbamazepine), 2019 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 9 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.33[0.91; 1.95]164,5303,23165%NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 3 unexposed, sickunexposed, sick 1.06[0.82; 1.37]6262,7580%NADreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 4 exposed to other treatment, sickexposed to other treatment, sick 0.96[0.31; 2.92]15690%NAHuber-Mollema (Carbamazepine), 2019 Cohen (Carbamazepine), 2013 2 Tags Adjustment   - No  - No 1.10[0.46; 2.62]241620%NAHuber-Mollema (Carbamazepine), 2019 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 5   - Yes  - Yes 1.18[0.96; 1.46]165,1475,89649%NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 4 Partial overlappingPartial overlapping 1.05[0.92; 1.19]147,8652,427 -NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 1 All studiesAll studies 1.11[0.98; 1.27]165,1716,0585%NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Huber-Mollema (Carbamazepine), 2019 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 90.010.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.94.01.9810.000Madley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023Huber-Mollema (Carbamazepine), 2019Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019Bromley (Carbamazepine) (Controls unexposed, sick), 2013Cohen (Carbamazepine), 2013Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013Viinikainen (Carbamazepine) b, 2006

Asymetry test p-value = 0.4724 (by Egger's regression)

slope=0.0521 (0.0777); intercept=0.3523 (0.4639); t=0.7595; p=0.4724

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9696, 9699, 9743, 9745, 9734, 15231, 17405, 17407, 17280, 17272

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.42[0.97; 2.09]166,2763,31254%NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Bromley (Carbamazepine) (Controls unexposed, disease free), 2013 Veiby (Carbamazepine) (Controls unexposed, disease free) b, 2013 5 unexposed, sick controlsunexposed, sick controls 1.06[0.82; 1.37]6262,7580%NADreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.12[0.81; 1.54]7626,04657%NAMadley-Dowd_SE (Carbamazepine) (Controls exposed to LTG) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls exposed to LTG) (Mixed indications), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls exposed to LTG), 2023 Huber-Mollema (Carbamazepine), 2019 Richards (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Indications NOS), 2019 Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls exposed to Lamotrigine, sick) b, 2013 8 siblingssiblings 0.97[0.68; 1.37]--0%NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, sibling) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sibling) (Mixed indications), 2024 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Xu (All indications) (ADHD)Xu (All indications) (ADHD) 1.11[0.93; 1.34]0%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Veroniki b (NMA) (Attention deficit hyperacti ...Veroniki b (NMA) (Attention deficit hyperactivity disorder) 2.32[0.70; 7.86]NA-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT-9 metaPregmetaPreg 1.11[0.98; 1.27]5%6,058----Madley-Dowd_SE (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, general pop) (Mixed indications), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Huber-Mollema (Carbamazepine), 2019 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 90.510.01.0