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

Low Apgar score (< 7) (at 5 min)

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.
S13863
R54230		 Mazkereth - Beta-blockers, 2019 Apgar 5 min < 7 during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched 3.02 [0.12;74.72] C 1/153   0/153 1 153
ref
S13902
R54402		 Duan - Beta-blockers, 2018 Low APGAR score (<7) at 5 min 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 2.93 [2.42;3.54] C 113/4,847   3,024/374,391 3,137 4,847
ref
S14079
R55426		 Gandjbakhch - Beta-blockers, 2018 Apgar 5 min < 7 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, ...) 2.92 [0.05;155.07] C 0/13   0/37 0 13
ref
S13480
R52003		 Orbach - Atenolol, 2013 Apgar score <=7 at 5 min 3rd trimester retrospective cohort (claims database) unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 0.44 [0.03;7.13] C 0/107   1,026/97,820 1,026 107
ref
S13846
R54253		 Darcie - Atenolol, 2004 Apgar score (fifth minute) < 7 late pregnancy prospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 0.34 [0.01;18.08] C 0/40   0/14 0 40
ref
S13816
R54639		 Sibai - Labetalol, 1990 Apgar score <7 at 5 minutes 2nd and/or 3rd trimester randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: Only chronic hypertension indication 1.05 [0.25;4.33] C 4/86   4/90 8 86
ref
S13947
R54586		 Fidler - Oxprenolol, 1983 Apgar score < 7 (at 5 min) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched 0.63 [0.06;6.24] C 1/49   3/94 4 49
ref
Total 7 studies 2.33 [1.47;3.67] 4,176 5,295
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 Mazkereth - Beta-blockers, 2019Mazkereth - Beta-blockers, 2019 3.02[0.12; 74.72]11532%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Duan - Beta-blockers, 2018Duan - Beta-blockers, 2018 2.93[2.42; 3.54]3,1374,84780%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Gandjbakhch - Beta-blockers, 2018Gandjbakhch - Beta-blockers, 2018 2.92[0.05; 155.07]0131%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Orbach - Atenolol, 2013Orbach - Atenolol, 2013 0.44[0.03; 7.13]1,0261073%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Darcie - Atenolol, 2004Darcie - Atenolol, 2004 0.34[0.01; 18.08]0401%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Sibai - Labetalol, 1990Sibai - Labetalol, 1990 1.05[0.25; 4.33]8869%ROB confusion: lowROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Fidler - Oxprenolol, 1983Fidler - Oxprenolol, 1983 0.63[0.06; 6.24]4494%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Total (7 studies) I2 = 7% 2.33[1.47; 3.67]4,1765,2950.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.86[2.37; 3.46]4,1685,2090%NAMazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Orbach - Atenolol, 2013 Darcie - Atenolol, 2004 Fidler - Oxprenolol, 1983 6 case control studiescase control studies 0 RCTRCT 1.05[0.25; 4.33]886 -NASibai - Labetalol, 1990 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.62[0.47; 5.54]4,1675,00342%NADuan - Beta-blockers, 2018 Orbach - Atenolol, 2013 Fidler - Oxprenolol, 1983 3 unexposed, sickunexposed, sick 1.20[0.37; 3.89]92920%NAMazkereth - Beta-blockers, 2019 Gandjbakhch - Beta-blockers, 2018 Darcie - Atenolol, 2004 Sibai - Labetalol, 1990 4 Tags Adjustment   - No  - No 2.86[2.37; 3.46]4,1685,2090%NAMazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Orbach - Atenolol, 2013 Darcie - Atenolol, 2004 Fidler - Oxprenolol, 1983 6   - Randomisation  - Randomisation 1.05[0.25; 4.33]886 -NASibai - Labetalol, 1990 1 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 2.16[1.07; 4.36]4,1685,19612%NAMazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Orbach - Atenolol, 2013 Darcie - Atenolol, 2004 Fidler - Oxprenolol, 1983 5   - Only cardiac indications other than ...  - Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 2.92[0.05; 155.07]-13 -NAGandjbakhch - Beta-blockers, 2018 1   - Only chronic hypertension indication  - Only chronic hypertension indication 1.05[0.25; 4.33]886 -NASibai - Labetalol, 1990 1 MatchedMatched 1.07[0.17; 6.91]52020%NAMazkereth - Beta-blockers, 2019 Fidler - Oxprenolol, 1983 2 All studiesAll studies 2.33[1.47; 3.67]4,1765,2957%NAMazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Orbach - Atenolol, 2013 Darcie - Atenolol, 2004 Sibai - Labetalol, 1990 Fidler - Oxprenolol, 1983 70.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.85.62.4320.000Mazkereth - Beta-blockers, 2019Duan - Beta-blockers, 2018Gandjbakhch - Beta-blockers, 2018Orbach - Atenolol, 2013Darcie - Atenolol, 2004Sibai - Labetalol, 1990Fidler - Oxprenolol, 1983

Asymetry test p-value = 0.0338 (by Egger's regression)

slope=1.1554 (0.0781); intercept=-0.9000 (0.3103); t=2.9000; p=0.0338

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.62[0.47; 5.54]4,1675,00342%NADuan - Beta-blockers, 2018 Orbach - Atenolol, 2013 Fidler - Oxprenolol, 1983 3 unexposed, sick controlsunexposed, sick controls 1.20[0.37; 3.89]92920%NAMazkereth - Beta-blockers, 2019 Gandjbakhch - Beta-blockers, 2018 Darcie - Atenolol, 2004 Sibai - Labetalol, 1990 40.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Magee (Apgar score less than 7 at 5 minutes)Magee (Apgar score less than 7 at 5 minutes) 1.78[0.63; 4.99]NA-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT2 Magee (Apgar score less than 7 at 5 minutes)Magee (Apgar score less than 7 at 5 minutes) 0.76[0.38; 1.52]0%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT6 Shekhar (Intravenous labetalol) - GESTATIONAL ...Shekhar (Intravenous labetalol) - GESTATIONAL HYPERTENSION (Low Apgar score at 5 min) 2.08[0.40; 11.10]NA-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT2 Shi (Intravenous Labetalol) - GESTATIONAL HYP ...Shi (Intravenous Labetalol) - GESTATIONAL HYPERTENSION (Neonate 5-min Apgar score < 7 (versus oral nifedipine)) Out of scale0.48[0.09; 2.50]0%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT2 Magee (Respiratory distress syndrome)Magee (Respiratory distress syndrome) 0.62[0.16; 2.37]56%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT2 metaPregmetaPreg 2.33[1.47; 3.67]7%5,295----Mazkereth - Beta-blockers, 2019 Duan - Beta-blockers, 2018 Gandjbakhch - Beta-blockers, 2018 Orbach - Atenolol, 2013 Darcie - Atenolol, 2004 Sibai - Labetalol, 1990 Fidler - Oxprenolol, 1983 70.510.01.0