Beta-blockers (All routes except ocular) (versus unexposed) updated on 12-17-2024

Caesarean

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.
S17127
R71743		 Delteil - Beta-blockers, 2024 Caesarean (planned or unplanned) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.09 [1.81;2.42] C 269/910   15,460/92,608 15,729 910
ref
S17156
R71952		 Vaclavik - Beta-blockers, 2024 Caesarean section during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.46 [2.32;2.61] -/2,032   -/252,856 - 2,032
ref
S17235
R72133		 Kubota - Beta-blockers, 2023 Cesarean during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 2.45 [0.64;9.45] C 8/11   137/263 145 11
ref
S14051
R55680		 Xiang - Labetalol, 2020 Cesarean delivery during pregnancy (anytime or not specified) randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: Only chronic hypertension indication 0.92 [0.54;1.57] C 38/127   40/126 78 127
ref
S13863
R54228		 Mazkereth - Beta-blockers, 2019 Caesarean section (elective and urgent) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched 2.19 [1.37;3.51] C 73/153   45/153 118 153
ref
S13902
R54407		 Duan - Beta-blockers, 2018 Cesarean during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.66 [2.51;2.82] C 2,455/4,847   104,203/374,391 106,658 4,847
ref
S14079
R55422		 Gandjbakhch - Beta-blockers, 2018 C-section during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 7.08 [1.39;35.99] C 5/13   3/37 8 13
ref
S13809
R54312		 Hoeltzenbein c - Bisoprolol, 2018 C-section at least 1st trimester excluded prospective cohort unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.11 [1.58;2.81] C
excluded (exposition period) 		140/291   181/592 321 291
ref
S13891
R54553		 Ishibashi - Beta-blockers, 2017 Caesarean section during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 3.21 [1.38;7.46] 22/38   22/87 44 38
ref
S14071
R55395		 Tanaka - Beta-blockers, 2016 Cesarean during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 1.24 [0.61;2.51] C 24/45   48/100 72 45
ref
S13958
R54677		 Ersboll - Beta-blockers (Controls unexposed, disease free), 2014 Caesarean (emergency and planned) during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free excluded Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) Matched 2.68 [1.50;4.80] C
excluded (control group) 		23/51   147/627 170 51
ref
S13957
R54666		 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 Caesarean (emergency and planned) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 2.01 [1.02;3.94] C 23/51   36/124 59 51
ref
S13846
R54254		 Darcie - Atenolol, 2004 Cesarean late pregnancy prospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.25 [0.63;8.07] C 30/40   8/14 38 40
ref
S13587
R52683		 Lydakis - Atenolol, 1999 Emergency Cesarean during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 4.34 [1.81;10.39] C 23/78   8/91 31 78
ref
S13976
R54827		 Cruickshank - Labetalol, 1991 Emergency caesarean sections 3rd trimester randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: All hypertensions, any indications or not specified 0.57 [0.20;1.63] C 6/51   12/63 18 51
ref
S14027
R55130		 Rosenfeld - Pindolol, 1986 Cesarean section during pregnancy (anytime or not specified) randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: All hypertensions, any indications or not specified 1.35 [0.41;4.46] C 10/23   8/22 18 23
ref
S13947
R54584		 Fidler - Oxprenolol, 1983 Elective caesarean section during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched 1.52 [0.64;3.62] C 11/50   15/96 26 50
ref
Total 15 studies 2.19 [1.91;2.51] 123,042 8,469
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 Delteil - Beta-blockers, 2024Delteil - Beta-blockers, 2024 2.09[1.81; 2.42]15,72991020%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Vaclavik - Beta-blockers, 2024Vaclavik - Beta-blockers, 2024 2.46[2.32; 2.61]-2,03225%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: unclear Kubota - Beta-blockers, 2023Kubota - Beta-blockers, 2023 2.45[0.64; 9.45]145111%ROB confusion: criticalROB selection: unclearROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: critical Xiang - Labetalol, 2020Xiang - Labetalol, 2020 0.92[0.54; 1.57]781275%ROB confusion: lowROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Mazkereth - Beta-blockers, 2019Mazkereth - Beta-blockers, 2019 2.19[1.37; 3.51]1181536%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Duan - Beta-blockers, 2018Duan - Beta-blockers, 2018 2.66[2.51; 2.82]106,6584,84725%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Gandjbakhch - Beta-blockers, 2018Gandjbakhch - Beta-blockers, 2018 7.08[1.39; 35.99]8131%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: criticalROB reporting: moderate Ishibashi - Beta-blockers, 2017Ishibashi - Beta-blockers, 2017 3.21[1.38; 7.46]44382%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: low Tanaka - Beta-blockers, 2016Tanaka - Beta-blockers, 2016 1.24[0.61; 2.51]72453%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Ersboll - Beta-blockers (Controls unexposed, sick), 2014Ersboll - Beta-blockers, 2014 1 2.01[1.02; 3.94]59514%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Darcie - Atenolol, 2004Darcie - Atenolol, 2004 2.25[0.63; 8.07]38401%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Lydakis - Atenolol, 1999Lydakis - Atenolol, 1999 4.34[1.81; 10.39]31782%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Cruickshank - Labetalol, 1991Cruickshank - Labetalol, 1991 0.57[0.20; 1.63]18512%ROB confusion: lowROB selection: unclearROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Rosenfeld - Pindolol, 1986Rosenfeld - Pindolol, 1986 1.35[0.41; 4.46]18231%ROB confusion: lowROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Fidler - Oxprenolol, 1983Fidler - Oxprenolol, 1983 1.52[0.64; 3.62]26502%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Total (15 studies) I2 = 67% 2.19[1.91; 2.51]123,0428,4690.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.41[2.20; 2.65]122,9288,26845%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Kubota - Beta-blockers, 2023 Mazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 Darcie - Atenolol, 2004 Lydakis - Atenolol, 1999 Fidler - Oxprenolol, 1983 12 case control studiescase control studies 0 RCTRCT 0.89[0.57; 1.38]1142010%NAXiang - Labetalol, 2020 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 3 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.43[2.19; 2.69]122,4137,83975%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Duan - Beta-blockers, 2018 Fidler - Oxprenolol, 1983 4 unexposed, sickunexposed, sick 1.85[1.27; 2.69]62963053%NAKubota - Beta-blockers, 2023 Xiang - Labetalol, 2020 Mazkereth - Beta-blockers, 2019 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 Darcie - Atenolol, 2004 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 11 Tags Adjustment   - No  - No 2.41[2.20; 2.65]122,9288,26845%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Kubota - Beta-blockers, 2023 Mazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 Darcie - Atenolol, 2004 Lydakis - Atenolol, 1999 Fidler - Oxprenolol, 1983 12   - Randomisation  - Randomisation 0.89[0.57; 1.38]1142010%NAXiang - Labetalol, 2020 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 3 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 2.34[2.09; 2.63]122,6058,10667%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Mazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Darcie - Atenolol, 2004 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 Fidler - Oxprenolol, 1983 8   - Only cardiac indications other than ...  - Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 2.18[1.36; 3.50]32815825%NAKubota - Beta-blockers, 2023 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 5   - Only chronic hypertension indication  - Only chronic hypertension indication 1.92[0.42; 8.77]10920589%NAXiang - Labetalol, 2020 Lydakis - Atenolol, 1999 2 MatchedMatched 2.02[1.33; 3.05]1442030%NAMazkereth - Beta-blockers, 2019 Fidler - Oxprenolol, 1983 2 All studiesAll studies 2.19[1.91; 2.51]123,0428,46967%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Kubota - Beta-blockers, 2023 Xiang - Labetalol, 2020 Mazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 Darcie - Atenolol, 2004 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 Fidler - Oxprenolol, 1983 150.220.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.32.70.9950.000Delteil - Beta-blockers, 2024Vaclavik - Beta-blockers, 2024Kubota - Beta-blockers, 2023Xiang - Labetalol, 2020Mazkereth - Beta-blockers, 2019Duan - Beta-blockers, 2018Gandjbakhch - Beta-blockers, 2018Ishibashi - Beta-blockers, 2017Tanaka - Beta-blockers, 2016Ersboll - Beta-blockers (Controls unexposed, sick), 2014Darcie - Atenolol, 2004Lydakis - Atenolol, 1999Cruickshank - Labetalol, 1991Rosenfeld - Pindolol, 1986Fidler - Oxprenolol, 1983

Asymetry test p-value = 0.0891 (by Egger's regression)

slope=0.9542 (0.0382); intercept=-0.9178 (0.4995); t=1.8375; p=0.0891

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13958

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.44[2.21; 2.68]122,5837,89066%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Duan - Beta-blockers, 2018 Ersboll - Beta-blockers (Controls unexposed, disease free), 2014 Fidler - Oxprenolol, 1983 5 unexposed, sick controlsunexposed, sick controls 1.85[1.27; 2.69]62963053%NAKubota - Beta-blockers, 2023 Xiang - Labetalol, 2020 Mazkereth - Beta-blockers, 2019 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 Darcie - Atenolol, 2004 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 110.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Alavifard (Caesarean delivery (versus Hydrala ...Alavifard (Caesarean delivery (versus Hydralazine)) 0.96[0.50; 1.93]-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Alavifard (Labetalol) (Caesarean delivery (ve ...Alavifard (Labetalol) (Caesarean delivery (versus Hydralazine)) 0.96[0.50; 1.93]-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Alavifard (Caesarean delivery (versus Nifedipine))Alavifard (Caesarean delivery (versus Nifedipine)) 0.94[0.45; 2.15]-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Alavifard (Labetalol) (Caesarean delivery (ve ...Alavifard (Labetalol) (Caesarean delivery (versus Nifedipine)) 0.94[0.45; 2.15]-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Magee (Caesarean section)Magee (Caesarean section) 0.95[0.80; 1.12]9%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT12 Magee (Caesarean section)Magee (Caesarean section) 1.01[0.84; 1.21]0%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT11 Shekhar (Intravenous labetalol) - GESTATIONAL ...Shekhar (Intravenous labetalol) - GESTATIONAL HYPERTENSION (Caesarean section) 1.02[0.77; 1.33]NA-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT4 Firoz (Labetalol) (Caesarean section (Labetal ...Firoz (Labetalol) (Caesarean section (Labetalol iv versus Nifedipine)) 0.81[0.51; 1.32]NA-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT1 Firoz (Labetalol) (Caesarean section (Labetal ...Firoz (Labetalol) (Caesarean section (Labetalol versus Methyldopa)) 0.85[0.56; 1.30]NA-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT1 Abalos (Caesarean section (RCT versus no anti ...Abalos (Caesarean section (RCT versus no antihypertensive drugs/placebo)) 1.06[0.86; 1.31]0%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT8 Bellos - Atenolol (Cesarean delivery (Randomi ...Bellos - Atenolol (Cesarean delivery (Randomized controlled trial and Cohort studies)) 3.77[1.27; 11.19]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Labetalol (Cesarean delivery (Random ...Bellos - Labetalol (Cesarean delivery (Randomized controlled trial and Cohort studies)) 0.96[0.59; 1.57]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Oxprenolol (Cesarean delivery (Rando ...Bellos - Oxprenolol (Cesarean delivery (Randomized controlled trial and Cohort studies)) 0.55[0.15; 1.99]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Labetalol (Cesarean delivery (Random ...Bellos - Labetalol (Cesarean delivery (Randomized controlled trial only)) 0.96[0.59; 1.57]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Oxprenolol (Cesarean delivery (Rando ...Bellos - Oxprenolol (Cesarean delivery (Randomized controlled trial only)) 0.55[0.15; 1.99]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 metaPregmetaPreg 2.19[1.91; 2.51]67%8,469----Delteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Kubota - Beta-blockers, 2023 Xiang - Labetalol, 2020 Mazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Ersboll - Beta-blockers (Controls unexposed, sick), 2014 Darcie - Atenolol, 2004 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 Fidler - Oxprenolol, 1983 150.510.01.0