Carbamazepine (All indications)

Cognitive developmental disorders/delay (> 6 years old)

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.
S12897
R53309
Adams (Carbamazepine), 2022 Full Scale IQ - The Wechsler Intelligence Scale for Children, 3rd Edition (WISC-III) (mean >6 years old) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No extrapolated (cont. endpoint) Matched 2.98 [1.33;6.66] -/41   -/41 - 41
ref
S12749
R53319
Bjørk (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2022 Diagnosis of intellectual disability (ID): mild ID (F70), moderate ID (F71), severe ID (F72), and profound ID (F73) (between 6.1 and 7.9 years old) during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 3.28 [1.99;5.41] C
excluded (control group)
36/3,256   27/7,950 63 3,256
ref
S12748
R53320
Bjørk (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2022 Diagnosis of intellectual disability (ID): mild ID (F70), moderate ID (F71), severe ID (F72), and profound ID (F73) (between 6.1 and 7.9 years old) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: Yes 2.01 [1.45;2.79]
excluded (control group)
36/3,256   16,384/4,463,879 16,420 3,256
ref
S12747
R53321
Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Diagnosis of intellectual disability (ID): mild ID (F70), moderate ID (F71), severe ID (F72), and profound ID (F73) (between 6.1 and 7.9 years old) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No Controls: epilepsy indication 1.73 [1.20;2.50] C 36/3,256   139/21,634 175 3,256
ref
S15378
R63362
Thomas (Carbamazepine), 2022 Full-scale IQ - Wechsler Intelligence Scale for Children or Adult - Ages 13 to 21 years (mean of 16.5 ± 2.2 years) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No extrapolated (cont. endpoint) 1.85 [0.55;6.31] -/38   -/11 - 38
ref
S9691
R53310
Baker (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2015 Mean child Full scale IQ - Differential ability scales (DAS) (age mean >6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No extrapolated (cont. endpoint) 0.77 [0.34;1.77]
excluded (control group)
-/50   -/29 - 50
ref
S9692
R53311
Baker (Carbamazepine) (Controls unexposed, disease free), 2015 IQ <85 - Differential ability scales (DAS) (age mean >6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: Yes 3.50 [1.10;10.20]
excluded (control group)
-/50   -/210 - 50
ref
S9693
R53312
Baker (Carbamazepine) (Controls unexposed, sick), 2015 Mean child Full scale IQ - Differential ability scales (DAS) (age mean >6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No extrapolated (cont. endpoint) 0.88 [0.37;2.11] -/50   -/25 - 50
ref
S9732
R53316
Meador (Carbamazepine), 2013 IQ <85 (DAS) (at 6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: Yes 3.21 [0.60;17.19] C 5/61   2/74 7 61
ref
S9733
R53317
Nadebaum (Carbamazepine), 2011 Full-scale child's IQ (Wechsler Intelligence Scale for Children (WISC)) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No extrapolated (cont. endpoint) 1.82 [0.48;6.95] -/34   -/9 - 34
ref
S9738
R53324
Titze (Carbamazepine) (Controls unexposed, disease free), 2008 Learning disability (IQ<70) (German versions of the revised Wechsler Intelligence Scales for children and for adults) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No Matched 13.86 [0.24;809.27] C
excluded (control group)
0/4   0/49 0 4
ref
S9739
R53325
Titze (Carbamazepine) (Controls unexposed, sick), 2008 Learning disability (IQ<70) (German versions of the revised Wechsler Intelligence Scales for children and for adults) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 1.10 [0.04;33.38] C 0/4   1/13 1 4
ref
S9747
R53318
Viinikainen (Carbamazepine) b, 2006 Full Scale IQ (FIQ) < 1SD (Wechsler Intelligence Scale for Children (WISC-III)) throughout pregnancy prospective cohort unexposed, sick Adjustment: No 5.95 [0.26;138.26] C 2/13   0/13 2 13
ref
S9748
R53326
Vinten (Carbamazepine), 2005 IQ score <69 (Wechsler Intelligence Scale for Children (WISC-III)) (Aged between 6 and 16 years) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 1.03 [0.28;3.83] C 4/52   6/80 10 52
ref
S9593
R53308
Adab (Carbamazepine), 2004 Mean Full Scale IQ (Wechsler Intelligence Scale for Children (WISC)) (Aged between 6 and 16 years) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No extrapolated (cont. endpoint) 0.85 [0.45;1.60] -/52   -/80 - 52
ref
S9720
R53313
Gaily (Carbamazepine) (Controls unexposed, disease free), 2004 Full scale IQ (Wechsler Preschool and Primary Scale of Intelligence Revised (WPPSI-R) or Wechsler Intelligence Scale for Children Revised (WISC-R)) 2nd and/or 3rd trimester prospective cohort unexposed, disease free excluded Adjustment: No extrapolated (cont. endpoint) 0.80 [0.49;1.30]
excluded (control group)
-/86   -/140 - 86
ref
S9721
R53314
Gaily (Carbamazepine) (Controls unexposed, sick), 2004 Full scale IQ (Wechsler Preschool and Primary Scale of Intelligence Revised (WPPSI-R) or Wechsler Intelligence Scale for Children Revised (WISC-R)) 2nd and/or 3rd trimester prospective cohort unexposed, sick Adjustment: No extrapolated (cont. endpoint) 0.65 [0.34;1.26] -/86   -/45 - 86
ref
Total 11 studies 1.34 [0.94;1.92] 195 3,687
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 Adams (Carbamazepine), 2022Adams, 2022 1 2.98[1.33; 6.66]-4112%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: lowROB mesure: lowROB reporting: moderate Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022Bjørk, 2022 2 1.73[1.20; 2.50]1753,25623%ROB confusion: unclearROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Thomas (Carbamazepine), 2022Thomas, 2022 3 1.85[0.55; 6.31]-387%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: criticalROB mesure: lowROB reporting: moderate Baker (Carbamazepine) (Controls unexposed, sick), 2015Baker, 2015 4 0.88[0.37; 2.11]-5011%ROB confusion: unclearROB selection: lowROB classification: moderateROB missing: moderateROB mesure: lowROB reporting: moderate Meador (Carbamazepine), 2013Meador, 2013 5 3.21[0.60; 17.19]7614%ROB confusion: moderateROB selection: lowROB classification: lowROB missing: moderateROB mesure: lowROB reporting: low Nadebaum (Carbamazepine), 2011Nadebaum, 2011 6 1.82[0.48; 6.95]-346%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: criticalROB mesure: lowROB reporting: moderate Titze (Carbamazepine) (Controls unexposed, sick), 2008Titze, 2008 7 1.10[0.04; 33.38]141%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Viinikainen (Carbamazepine) b, 2006Viinikainen, 2006 8 5.95[0.26; 138.26]2131%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: moderateROB mesure: lowROB reporting: moderate Vinten (Carbamazepine), 2005Vinten, 2005 9 1.03[0.28; 3.83]10526%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: criticalROB mesure: lowROB reporting: moderate Adab (Carbamazepine), 2004Adab, 2004 10 0.85[0.45; 1.60]-5215%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: criticalROB mesure: lowROB reporting: moderate Gaily (Carbamazepine) (Controls unexposed, sick), 2004Gaily, 2004 11 0.65[0.34; 1.26]-8615%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: lowROB reporting: moderate Total (11 studies) I2 = 36% 1.34[0.94; 1.92]1953,6870.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Carbamazepine; 2: Carbamazepine) (Controls unexposed, sick) (Mixed indications; 3: Carbamazepine; 4: Carbamazepine) (Controls unexposed, sick; 5: Carbamazepine; 6: Carbamazepine; 7: Carbamazepine) (Controls unexposed, sick; 8: Carbamazepine) ; 9: Carbamazepine; 10: Carbamazepine; 11: Carbamazepine) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.34[0.94; 1.92]1953,68736%NAAdams (Carbamazepine), 2022 Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Thomas (Carbamazepine), 2022 Baker (Carbamazepine) (Controls unexposed, sick), 2015 Meador (Carbamazepine), 2013 Nadebaum (Carbamazepine), 2011 Titze (Carbamazepine) (Controls unexposed, sick), 2008 Viinikainen (Carbamazepine) b, 2006 Vinten (Carbamazepine), 2005 Adab (Carbamazepine), 2004 Gaily (Carbamazepine) (Controls unexposed, sick), 2004 11 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 1.27[0.85; 1.89]1883,59245%NAAdams (Carbamazepine), 2022 Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Thomas (Carbamazepine), 2022 Baker (Carbamazepine) (Controls unexposed, sick), 2015 Titze (Carbamazepine) (Controls unexposed, sick), 2008 Viinikainen (Carbamazepine) b, 2006 Vinten (Carbamazepine), 2005 Adab (Carbamazepine), 2004 Gaily (Carbamazepine) (Controls unexposed, sick), 2004 9 exposed to other treatment, sickexposed to other treatment, sick 2.27[0.80; 6.45]7950%NAMeador (Carbamazepine), 2013 Nadebaum (Carbamazepine), 2011 2 Tags Adjustment   - No  - No 1.30[0.90; 1.87]1883,62639%NAAdams (Carbamazepine), 2022 Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Thomas (Carbamazepine), 2022 Baker (Carbamazepine) (Controls unexposed, sick), 2015 Nadebaum (Carbamazepine), 2011 Titze (Carbamazepine) (Controls unexposed, sick), 2008 Viinikainen (Carbamazepine) b, 2006 Vinten (Carbamazepine), 2005 Adab (Carbamazepine), 2004 Gaily (Carbamazepine) (Controls unexposed, sick), 2004 10   - Yes  - Yes 3.21[0.60; 17.19]761 -NAMeador (Carbamazepine), 2013 1 Controls   - epilepsy indication  - epilepsy indication 1.73[1.20; 2.50]1753,256 -NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 1 extrapolated (cont. endpoint)extrapolated (cont. endpoint) 1.20[0.72; 1.99]-30152%NAAdams (Carbamazepine), 2022 Thomas (Carbamazepine), 2022 Baker (Carbamazepine) (Controls unexposed, sick), 2015 Nadebaum (Carbamazepine), 2011 Adab (Carbamazepine), 2004 Gaily (Carbamazepine) (Controls unexposed, sick), 2004 6 MatchedMatched 2.98[1.33; 6.67]-41 -NAAdams (Carbamazepine), 2022 1 All studiesAll studies 1.34[0.94; 1.92]1953,68736%NAAdams (Carbamazepine), 2022 Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Thomas (Carbamazepine), 2022 Baker (Carbamazepine) (Controls unexposed, sick), 2015 Meador (Carbamazepine), 2013 Nadebaum (Carbamazepine), 2011 Titze (Carbamazepine) (Controls unexposed, sick), 2008 Viinikainen (Carbamazepine) b, 2006 Vinten (Carbamazepine), 2005 Adab (Carbamazepine), 2004 Gaily (Carbamazepine) (Controls unexposed, sick), 2004 110.220.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.14.42.0920.000Adams (Carbamazepine), 2022Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022Thomas (Carbamazepine), 2022Baker (Carbamazepine) (Controls unexposed, sick), 2015Meador (Carbamazepine), 2013Nadebaum (Carbamazepine), 2011Titze (Carbamazepine) (Controls unexposed, sick), 2008Viinikainen (Carbamazepine) b, 2006Vinten (Carbamazepine), 2005Adab (Carbamazepine), 2004Gaily (Carbamazepine) (Controls unexposed, sick), 2004

Asymetry test p-value = 0.7876 (by Egger's regression)

slope=0.2449 (0.3043); intercept=0.2082 (0.7500); t=0.2776; p=0.7876

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9720, 9738, 9691, 9692, 12749, 12748

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.74[0.82; 3.70]16,4203,39676%NABjørk (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2022 Baker (Carbamazepine) (Controls unexposed, disease free), 2015 Titze (Carbamazepine) (Controls unexposed, disease free), 2008 Gaily (Carbamazepine) (Controls unexposed, disease free), 2004 4 unexposed, sick controlsunexposed, sick controls 1.27[0.85; 1.89]1883,59245%NAAdams (Carbamazepine), 2022 Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Thomas (Carbamazepine), 2022 Baker (Carbamazepine) (Controls unexposed, sick), 2015 Titze (Carbamazepine) (Controls unexposed, sick), 2008 Viinikainen (Carbamazepine) b, 2006 Vinten (Carbamazepine), 2005 Adab (Carbamazepine), 2004 Gaily (Carbamazepine) (Controls unexposed, sick), 2004 9 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.91[0.83; 4.39]703,40166%NABjørk (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2022 Baker (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2015 Meador (Carbamazepine), 2013 Nadebaum (Carbamazepine), 2011 40.510.01.0