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

Congenital heart defects

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
R71755
Delteil - Beta-blockers, 2024 Circulatory system malformations 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: Only chronic indication (hypertension or cardiac) 1.62 [0.77;3.42] C 7/974   737/165,775 744 974
ref
S13518
R52242
Fitton - Beta-blockers (Controls unexposed, disease free), 2021 Circulatory defects (Q20-Q28) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, disease free excluded Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.26 [0.40;4.00]
excluded (control group)
5/985   873/252,598 878 985
ref
S13520
R52245
Fitton - Beta-blockers (Controls unexposed, sick), 2021 Circulatory defects (Q20-Q28) during pregnancy (anytime or not specified) excluded retrospective cohort (claims database) unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 1.93 [0.71;5.28] C
excluded (exposition period)
5/985   16/6,066 21 985
ref
S13539
R54082
Bateman_Nordic - Beta-blockers, 2018 Cardiac malformations 1st trimester population based cohort retrospective unexposed, sick Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 0.98 [0.52;1.84] 15/682   55/2,895 70 682
ref
S13791
R54089
Bateman_USMAX - Beta-blockers, 2018 Cardiac malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.16 [0.82;1.63] 37/1,668   224/13,232 261 1,668
ref
S13907
R54453
Bergman - Beta-blockers, 2018 Congenital heart defects 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 0.90 [0.70;1.20] 87/227   32,432/83,001 32,519 227
ref
S14079
R55429
Gandjbakhch - Beta-blockers, 2018 Cardiac malformations during pregnancy (anytime or not specified) excluded retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 3.72 [0.07;196.99] C
excluded (exposition period)
0/13   0/47 0 13
ref
S13901
R54392
Duan - Beta-blockers, 2017 Any cardiac anomalies 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.00 [0.80;1.30] 128/2,628   7,231/374,391 7,359 2,628
ref
S13888
R55949
Fisher - Beta-blockers (Controls unexposed, disease free), 2017 Any Congenital Heart Defects early pregnancy case control unexposed, disease free excluded Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.84 [1.25;2.72]
excluded (control group)
73/113   10,552/21,649 10,625 113
ref
S14244
R55961
Fisher - Beta-blockers (Controls unexposed, sick), 2017 Any Congenital Heart Defects early pregnancy case control unexposed, sick Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.62 [1.07;2.44] 73/113   -/- - 113
ref
S13441
R51785
Lennestal - Beta-blockers, 2009 Any cardiovascular defect early pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication 2.76 [1.79;4.08] 25/798   12,660/1,046,843 12,685 798
ref
S13375
R51734
Cedergren - Beta-blockers, 2002 Congenital heart defects early pregnancy nested case control unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched 0.28 [0.01;2.17] 1/8   268/785 269 8
ref
Total 8 studies 1.28 [0.95;1.72] 53,907 7,098
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 1.62[0.77; 3.42]7449749%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Bateman_Nordic - Beta-blockers, 2018Bateman_Nordic - Beta-blockers, 2018 0.98[0.52; 1.84]7068210%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Bateman_USMAX - Beta-blockers, 2018Bateman_USMAX - Beta-blockers, 2018 1.16[0.82; 1.63]2611,66816%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Bergman - Beta-blockers, 2018Bergman - Beta-blockers, 2018 0.90[0.70; 1.20]32,51922717%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: lowROB mesure: unclearROB reporting: moderate Duan - Beta-blockers, 2017Duan - Beta-blockers, 2017 1.00[0.80; 1.30]7,3592,62818%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: unclearROB reporting: NA Fisher - Beta-blockers (Controls unexposed, sick), 2017Fisher - Beta-blockers, 2017 1 1.62[1.07; 2.44]-11314%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Lennestal - Beta-blockers, 2009Lennestal - Beta-blockers, 2009 2.76[1.79; 4.08]12,68579814%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Cedergren - Beta-blockers, 2002Cedergren - Beta-blockers, 2002 0.28[0.01; 2.17]26981%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Total (8 studies) I2 = 74% 1.28[0.95; 1.72]53,9077,0980.210.01.0ROB: 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 1.37[0.91; 2.06]21,1196,75079%NADelteil - Beta-blockers, 2024 Bateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Duan - Beta-blockers, 2017 Lennestal - Beta-blockers, 2009 5 case control studiescase control studies 1.12[0.64; 1.94]32,78834869%NABergman - Beta-blockers, 2018 Fisher - Beta-blockers (Controls unexposed, sick), 2017 Cedergren - Beta-blockers, 2002 3 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.31[0.81; 2.12]53,5764,63583%NADelteil - Beta-blockers, 2024 Bergman - Beta-blockers, 2018 Duan - Beta-blockers, 2017 Lennestal - Beta-blockers, 2009 Cedergren - Beta-blockers, 2002 5 unexposed, sickunexposed, sick 1.27[0.98; 1.65]3312,46311%NABateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Fisher - Beta-blockers (Controls unexposed, sick), 2017 3 Tags Adjustment   - No  - No 1.11[0.27; 4.58]1,01398234%NADelteil - Beta-blockers, 2024 Cedergren - Beta-blockers, 2002 2   - Yes  - Yes 1.28[0.93; 1.76]52,8946,11680%NABateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Bergman - Beta-blockers, 2018 Duan - Beta-blockers, 2017 Fisher - Beta-blockers (Controls unexposed, sick), 2017 Lennestal - Beta-blockers, 2009 6 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 1.07[0.89; 1.29]40,4785,32628%NABateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Bergman - Beta-blockers, 2018 Duan - Beta-blockers, 2017 Fisher - Beta-blockers (Controls unexposed, sick), 2017 Cedergren - Beta-blockers, 2002 6   - Only chronic hypertension indication  - Only chronic hypertension indication 2.76[1.83; 4.17]12,685798 -NALennestal - Beta-blockers, 2009 1   - Only chronic indication (hypertensi ...  - Only chronic indication (hypertension or cardiac) 1.62[0.77; 3.42]744974 -NADelteil - Beta-blockers, 2024 1 MatchedMatched 0.28[0.02; 4.12]2698 -NACedergren - Beta-blockers, 2002 1 All studiesAll studies 1.28[0.95; 1.72]53,9077,09874%NADelteil - Beta-blockers, 2024 Bateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Bergman - Beta-blockers, 2018 Duan - Beta-blockers, 2017 Fisher - Beta-blockers (Controls unexposed, sick), 2017 Lennestal - Beta-blockers, 2009 Cedergren - Beta-blockers, 2002 80.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.23.51.6470.000Delteil - Beta-blockers, 2024Bateman_Nordic - Beta-blockers, 2018Bateman_USMAX - Beta-blockers, 2018Bergman - Beta-blockers, 2018Duan - Beta-blockers, 2017Fisher - Beta-blockers (Controls unexposed, sick), 2017Lennestal - Beta-blockers, 2009Cedergren - Beta-blockers, 2002

Asymetry test p-value = 0.6332 (by Egger's regression)

slope=0.0236 (0.3186); intercept=0.8261 (1.6438); t=0.5026; p=0.6332

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13888, 13518

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.40[0.92; 2.13]64,2014,74882%NADelteil - Beta-blockers, 2024 Bergman - Beta-blockers, 2018 Duan - Beta-blockers, 2017 Fisher - Beta-blockers (Controls unexposed, disease free), 2017 Lennestal - Beta-blockers, 2009 Cedergren - Beta-blockers, 2002 6 unexposed, sick controlsunexposed, sick controls 1.27[0.98; 1.65]3312,46311%NABateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Fisher - Beta-blockers (Controls unexposed, sick), 2017 30.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Yakoob (Cardiovascular abnormalities)Yakoob (Cardiovascular abnormalities) 2.01[1.18; 3.42]52%-Wwhatever (meta-analysis)T11st trimesterstudies TTT4 Ramakrishnan (Congenital heart defects)Ramakrishnan (Congenital heart defects) 2.10[1.64; 2.70]NA-Wwhatever (meta-analysis)T11st trimesterstudies TTT3 Wu (Heart malformations (adjusted studies))Wu (Heart malformations (adjusted studies)) 1.11[0.94; 1.32]41%-Wwhatever (meta-analysis)Earlyearly pregnancystudies TTT8 Wu (Heart malformations (all studies))Wu (Heart malformations (all studies)) 1.29[1.02; 1.62]67%-Wwhatever (meta-analysis)Earlyearly pregnancystudies TTT13 metaPregmetaPreg 1.28[0.95; 1.72]74%7,098----Delteil - Beta-blockers, 2024 Bateman_Nordic - Beta-blockers, 2018 Bateman_USMAX - Beta-blockers, 2018 Bergman - Beta-blockers, 2018 Duan - Beta-blockers, 2017 Fisher - Beta-blockers (Controls unexposed, sick), 2017 Lennestal - Beta-blockers, 2009 Cedergren - Beta-blockers, 2002 80.510.01.0