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

Major congenital malformations

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
R71753
Delteil - Beta-blockers, 2024 Major congenital malformations 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: Only chronic indication (hypertension or cardiac) 1.54 [1.08;2.13] 36/974   4,054/165,775 4,090 974
ref
S13539
R54081
Bateman_Nordic - Beta-blockers, 2018 Major congenital malformations (ICD-9: 740.xx-759.xx; ICD-10: Q00.0-Q89.9 (except Q17.0, Q38.1, Q53, Q65.0-Q65.6, Q82.5, Q86)) 1st trimester population based cohort retrospective unexposed, sick Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.22 [0.88;1.71] 48/682   152/2,895 200 682
ref
S13791
R54088
Bateman_USMAX - Beta-blockers, 2018 Major congenital malformations (ICD-9: 740.xx-759.xx; ICD-10: Q00.0-Q89.9 (except Q17.0, Q38.1, Q53, Q65.0-Q65.6, Q82.5, Q86)) 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.01 [0.80;1.27] 78/1,668   534/13,232 612 1,668
ref
S13809
R54309
Hoeltzenbein c - Bisoprolol, 2018 Major birth defects at least 1st trimester prospective cohort unexposed, disease free Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 0.77 [0.34;1.75] 10/294   28/611 38 294
ref
S13935
R54558
Vasilakis-Scaramozza - Beta-blockers, 2013 Any anomaly, excluding minor and chromosomal anomalies 1st trimester retrospective cohort unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.40 [0.60;3.20] 6/214   16/682 22 214
ref
S13474
R51971
Nakhai-Pour - Beta-blockers, 2010 Major malformations 1st trimester nested case control unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 0.99 [0.31;3.20] C 3/43   4,152/58,990 4,155 43
ref
S13584
R52672
Queisser-Luft - Beta-blockers, 1996 Major malformations throughout pregnancy nested case control unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 1.10 [0.30;3.40] -/-   1,481/- - -
ref
S14027
R55137
Rosenfeld - Pindolol, 1986 Major malformations during pregnancy (anytime or not specified) excluded randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: All hypertensions, any indications or not specified 0.17 [0.01;3.83] C
excluded (exposition period)
0/23   2/22 2 23
ref
Total 7 studies 1.16 [0.99;1.35] 9,117 3,875
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 1.54[1.08; 2.13]4,09097421%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Bateman_Nordic - Beta-blockers, 2018Bateman_Nordic - Beta-blockers, 2018 1.22[0.88; 1.71]20068222%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Bateman_USMAX - Beta-blockers, 2018Bateman_USMAX - Beta-blockers, 2018 1.01[0.80; 1.27]6121,66846%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Hoeltzenbein c - Bisoprolol, 2018Hoeltzenbein c - Bisoprolol, 2018 0.77[0.34; 1.75]382944%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Vasilakis-Scaramozza - Beta-blockers, 2013Vasilakis-Scaramozza - Beta-blockers, 2013 1.40[0.60; 3.20]222143%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Nakhai-Pour - Beta-blockers, 2010Nakhai-Pour - Beta-blockers, 2010 0.99[0.31; 3.20]4,155432%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Queisser-Luft - Beta-blockers, 1996Queisser-Luft - Beta-blockers, 1996 1.10[0.30; 3.40]--2%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: critical Total (7 studies) I2 = 0% 1.16[0.99; 1.35]9,1173,8750.25.01.0ROB: 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 1.18[0.96; 1.44]4,9623,83224%NADelteil - Beta-blockers, 2024 Bateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Vasilakis-Scaramozza - Beta-blockers, 2013 5 case control studiescase control studies 1.04[0.45; 2.42]4,155430%NANakhai-Pour - Beta-blockers, 2010 Queisser-Luft - Beta-blockers, 1996 2 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.35[1.02; 1.78]8,3051,5250%NADelteil - Beta-blockers, 2024 Hoeltzenbein c - Bisoprolol, 2018 Vasilakis-Scaramozza - Beta-blockers, 2013 Nakhai-Pour - Beta-blockers, 2010 Queisser-Luft - Beta-blockers, 1996 5 unexposed, sickunexposed, sick 1.07[0.89; 1.30]8122,3500%NABateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 2 Tags Adjustment   - No  - No 1.04[0.45; 2.42]4,155430%NANakhai-Pour - Beta-blockers, 2010 Queisser-Luft - Beta-blockers, 1996 2   - Yes  - Yes 1.18[0.96; 1.44]4,9623,83224%NADelteil - Beta-blockers, 2024 Bateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Vasilakis-Scaramozza - Beta-blockers, 2013 5 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 1.07[0.90; 1.28]5,0272,9010%NABateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Vasilakis-Scaramozza - Beta-blockers, 2013 Nakhai-Pour - Beta-blockers, 2010 Queisser-Luft - Beta-blockers, 1996 6   - Only chronic indication (hypertensi ...  - Only chronic indication (hypertension or cardiac) 1.54[1.10; 2.16]4,090974 -NADelteil - Beta-blockers, 2024 1 All studiesAll studies 1.16[0.99; 1.35]9,1173,8750%NADelteil - Beta-blockers, 2024 Bateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Vasilakis-Scaramozza - Beta-blockers, 2013 Nakhai-Pour - Beta-blockers, 2010 Queisser-Luft - Beta-blockers, 1996 70.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.51.60.7430.000Delteil - Beta-blockers, 2024Bateman_Nordic - Beta-blockers, 2018Bateman_USMAX - Beta-blockers, 2018Hoeltzenbein c - Bisoprolol, 2018Vasilakis-Scaramozza - Beta-blockers, 2013Nakhai-Pour - Beta-blockers, 2010Queisser-Luft - Beta-blockers, 1996

Asymetry test p-value = 0.9935 (by Egger's regression)

slope=0.1454 (0.1575); intercept=-0.0064 (0.7453); t=0.0085; p=0.9935

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) 1.35[1.02; 1.78]9,7771,5250%NADelteil - Beta-blockers, 2024 Hoeltzenbein c - Bisoprolol, 2018 Vasilakis-Scaramozza - Beta-blockers, 2013 Nakhai-Pour - Beta-blockers, 2010 Queisser-Luft - Beta-blockers, 1996 5 unexposed, sick controlsunexposed, sick controls 1.07[0.89; 1.30]8122,3500%NABateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Wu (Overall (not organ-specific) major malfor ...Wu (Overall (not organ-specific) major malformations (adjusted studies)) 1.01[0.93; 1.10]63%-Wwhatever (meta-analysis)Earlyearly pregnancystudies TTT7 Wu (Overall (not organ-specific) major malfor ...Wu (Overall (not organ-specific) major malformations (all studies)) 1.01[0.93; 1.09]0%-Wwhatever (meta-analysis)Earlyearly pregnancystudies TTT10 Wu (Overall (not organ-specific) major malfor ...Wu (Overall (not organ-specific) major malformations (high quality studies)) 1.01[0.93; 1.09]0%-Wwhatever (meta-analysis)Earlyearly pregnancystudies TTT8 metaPregmetaPreg 1.16[0.99; 1.35]0%3,875----Delteil - Beta-blockers, 2024 Bateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Vasilakis-Scaramozza - Beta-blockers, 2013 Nakhai-Pour - Beta-blockers, 2010 Queisser-Luft - Beta-blockers, 1996 70.510.01.0