Carbamazepine (All indications)

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.
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
S9749
R46371
Wiggs (Carbamazepine), 2020 Attention-deficit/hyperactivity disorder (after 2 years of age) at least 1st trimester population based cohort retrospective unexposed, sick Adjustment: Yes 1.18 [0.91;1.52] -/-   -/11,298 - -
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 8 studies 1.18 [1.00;1.40] 12,499 3,028
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 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023Dreier, 2023 1 1.05[0.81; 1.37]6172,66541%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Wiggs (Carbamazepine), 2020Wiggs, 2020 2 1.18[0.91; 1.52]--43%ROB confusion: moderateROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Huber-Mollema (Carbamazepine), 2019Huber-Mollema, 2019 3 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 4 1.83[1.11; 3.02]11,85820111%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Bromley (Carbamazepine) (Controls unexposed, sick), 2013Bromley, 2013 5 1.58[0.06; 40.13]1500%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Cohen (Carbamazepine), 2013Cohen, 2013 6 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 7 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 8 0.15[0.01; 3.50]2120%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: moderateROB mesure: lowROB reporting: moderate Total (8 studies) I2 = 0% 1.18[1.00; 1.40]12,4993,0280.010.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

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

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.18[1.00; 1.40]12,4993,0280%NADreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Wiggs (Carbamazepine), 2020 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 8 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 1.12[0.93; 1.34]6262,7580%NADreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Wiggs (Carbamazepine), 2020 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 5 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 1.22[0.95; 1.57]12,4752,86646%NADreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Wiggs (Carbamazepine), 2020 Richards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 3 All studiesAll studies 1.18[1.00; 1.40]12,4993,0280%NADreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Wiggs (Carbamazepine), 2020 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 80.010.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.94.01.9810.000Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023Wiggs (Carbamazepine), 2020Huber-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 = 0.9547 (by Egger's regression)

slope=0.1592 (0.1288); intercept=0.0313 (0.5281); t=0.0592; p=0.9547

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9696, 9699, 9743, 9745, 9734, 15231

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.93[1.21; 3.07]13,6042820%NARichards (Carbamazepine) (Controls unexposed, NOS) (Indications NOS), 2019 Bromley (Carbamazepine) (Controls unexposed, disease free), 2013 Veiby (Carbamazepine) (Controls unexposed, disease free) b, 2013 3 unexposed, sick controlsunexposed, sick controls 1.12[0.93; 1.34]6262,7580%NADreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Wiggs (Carbamazepine), 2020 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 5 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.42[0.98; 2.05]2353,01614%NADreier (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 60.510.01.0