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

Preterm (< 37 weeks)

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
R71769
Delteil - Beta-blockers, 2024 Preterm birth (<37 GW) at least 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: Only chronic indication (hypertension or cardiac) 1.34 [0.99;1.82] 42/453   6,845/141,888 6,887 453
ref
S17156
R71953
Vaclavik - Beta-blockers, 2024 Preterm delivery during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.04 [1.87;2.22] -/602   -/71,860 - 602
ref
S17151
R71927
Al Khalaf - Beta-blockers (Controls unexposed, disease free), 2022 Preterm birth (less than 37 weeks) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, disease free excluded Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 3.00 [2.59;3.47] C
excluded (control group)
199/1,952   63,460/1,739,944 63,659 1,952
ref
S17148
R71904
Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Preterm birth (less than 37 weeks) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 1.20 [1.01;1.41] C 199/1,952   677/7,809 876 1,952
ref
S13995
R54972
Baard - Beta-blockers, 2020 Preterm birth < 37 weeks during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 1.11 [0.50;2.44] C 11/43   32/135 43 43
ref
S13509
R52190
Fitton - Beta-blockers (Controls unexposed, disease free), 2020 Preterm birth (birth on or before 36 weeks gestation). 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 2.36 [1.83;3.05]
excluded (control group)
128/985   12,622/250,693 12,750 985
ref
S14420
R57246
Fitton - Beta-blockers (Controls unexposed, sick), 2020 Preterm birth (birth on or before 36 weeks gestation). during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 1.47 [1.20;1.79] C 128/985   736/7,971 864 985
ref
S13853
R54277
Kayser - Metoprolol/bisoprolol, 2020 Preterm birth (delivery before 37 completed gestational weeks) 2nd and/or 3rd trimester prospective cohort unexposed, disease free Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 2.20 [1.30;3.80] 45/294   56/588 101 294
ref
S14051
R55684
Xiang - Labetalol, 2020 Premature delivery (delivery before 37 weeks) during pregnancy (anytime or not specified) randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: Only chronic hypertension indication 0.79 [0.46;1.37] C 34/124   39/121 73 124
ref
S14079
R55421
Gandjbakhch - Beta-blockers, 2018 Preterm birth (<37 weeks of gestation) 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, ...) 3.00 [0.17;51.75] C 1/13   1/37 2 13
ref
S13891
R54554
Ishibashi - Beta-blockers, 2017 Premature birth (gestational period less than 37 weeks) 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, ...) 4.79 [1.51;15.21] 10/38   6/87 16 38
ref
S14071
R55397
Tanaka - Beta-blockers, 2016 Preterm births 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, ...) 1.85 [0.81;4.21] C 13/45   18/100 31 45
ref
S13480
R51999
Orbach - Atenolol, 2013 Preterm delivery (< 37 weeks of gestation) 3rd trimester retrospective cohort (claims database) unexposed, disease free Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 2.68 [1.57;4.56] 18/107   7,836/97,820 7,854 107
ref
S13448
R51807
Su - Beta-blockers (Controls unexposed, disease free), 2013 Preterm birth (< 37 completed weeks) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 2.69 [2.04;3.56] C
excluded (control group)
65/414   529/8,181 594 414
ref
S13442
R51789
Su - Beta-blockers (Controls unexposed, sick) , 2013 Preterm birth (< 37 completed weeks) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication 2.01 [1.42;2.86] 65/414   84/1,006 149 414
ref
S13882
R54320
Petersen - Beta-blockers, 2012 Preterm birth (birth before the 37th gestational week) 1st and 2nd trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication 2.26 [2.03;2.52] 697/2,459   109,163/909,226 109,860 2,459
ref
S13392
R54162
Ray - Beta-blockers, 2001 Preterm birth before 37 weeks gestation during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication 4.00 [2.30;6.90] 57/144   30/247 87 144
ref
S13587
R52684
Lydakis - Atenolol, 1999 Delivery <37 Weeks during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 2.75 [1.31;5.76] C 26/78   14/91 40 78
ref
S13976
R54826
Cruickshank - Labetalol, 1991 Preterm delivery (< 37 weeks) 3rd trimester randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: All hypertensions, any indications or not specified 0.94 [0.37;2.36] C 10/51   13/63 23 51
ref
S14027
R55127
Rosenfeld - Pindolol, 1986 Preterm (<37wk) during pregnancy (anytime or not specified) randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: All hypertensions, any indications or not specified 1.20 [0.31;4.69] C 6/23   5/22 11 23
ref
Total 17 studies 1.78 [1.49;2.13] 126,917 7,825
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 1.34[0.99; 1.82]6,8874539%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Vaclavik - Beta-blockers, 2024Vaclavik - Beta-blockers, 2024 2.04[1.87; 2.22]-60211%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: unclear Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022Al Khalaf - Beta-blockers, 2022 1 1.20[1.01; 1.41]8761,95211%ROB confusion: criticalROB selection: unclearROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Baard - Beta-blockers, 2020Baard - Beta-blockers, 2020 1.11[0.50; 2.44]43434%ROB confusion: seriousROB selection: unclearROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Fitton - Beta-blockers (Controls unexposed, sick), 2020Fitton - Beta-blockers, 2020 2 1.47[1.20; 1.79]86498510%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Kayser - Metoprolol/bisoprolol, 2020Kayser - Metoprolol/bisoprolol, 2020 2.20[1.30; 3.80]1012946%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Xiang - Labetalol, 2020Xiang - Labetalol, 2020 0.79[0.46; 1.37]731246%ROB confusion: lowROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Gandjbakhch - Beta-blockers, 2018Gandjbakhch - Beta-blockers, 2018 3.00[0.17; 51.75]2130%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Ishibashi - Beta-blockers, 2017Ishibashi - Beta-blockers, 2017 4.79[1.51; 15.21]16382%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: low Tanaka - Beta-blockers, 2016Tanaka - Beta-blockers, 2016 1.85[0.81; 4.21]31453%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Orbach - Atenolol, 2013Orbach - Atenolol, 2013 2.68[1.57; 4.56]7,8541076%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Su - Beta-blockers (Controls unexposed, sick) , 2013Su - Beta-blockers, 2013 3 2.01[1.42; 2.86]1494148%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Petersen - Beta-blockers, 2012Petersen - Beta-blockers, 2012 2.26[2.03; 2.52]109,8602,45911%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Ray - Beta-blockers, 2001Ray - Beta-blockers, 2001 4.00[2.30; 6.90]871446%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Lydakis - Atenolol, 1999Lydakis - Atenolol, 1999 2.75[1.31; 5.76]40784%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Cruickshank - Labetalol, 1991Cruickshank - Labetalol, 1991 0.94[0.37; 2.36]23513%ROB confusion: lowROB selection: unclearROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Rosenfeld - Pindolol, 1986Rosenfeld - Pindolol, 1986 1.20[0.31; 4.69]11231%ROB confusion: lowROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Total (17 studies) I2 = 80% 1.78[1.49; 2.13]126,9177,8250.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Controls unexposed, sick; 3: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.91[1.60; 2.29]126,8107,62781%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Baard - Beta-blockers, 2020 Fitton - Beta-blockers (Controls unexposed, sick), 2020 Kayser - Metoprolol/bisoprolol, 2020 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Orbach - Atenolol, 2013 Su - Beta-blockers (Controls unexposed, sick) , 2013 Petersen - Beta-blockers, 2012 Ray - Beta-blockers, 2001 Lydakis - Atenolol, 1999 14 case control studiescase control studies 0 RCTRCT 0.86[0.55; 1.35]1071980%NAXiang - Labetalol, 2020 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 3 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.03[1.74; 2.36]124,7023,91565%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Kayser - Metoprolol/bisoprolol, 2020 Orbach - Atenolol, 2013 Petersen - Beta-blockers, 2012 5 unexposed, sickunexposed, sick 1.64[1.26; 2.14]2,2153,91069%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Baard - Beta-blockers, 2020 Fitton - Beta-blockers (Controls unexposed, sick), 2020 Xiang - Labetalol, 2020 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Su - Beta-blockers (Controls unexposed, sick) , 2013 Ray - Beta-blockers, 2001 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 12 Tags Adjustment   - No  - No 1.71[1.28; 2.27]1,8723,75683%NAVaclavik - Beta-blockers, 2024 Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Baard - Beta-blockers, 2020 Fitton - Beta-blockers (Controls unexposed, sick), 2020 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Lydakis - Atenolol, 1999 8   - Randomisation  - Randomisation 0.86[0.55; 1.35]1071980%NAXiang - Labetalol, 2020 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 3   - Yes  - Yes 2.17[1.70; 2.78]124,9383,87168%NADelteil - Beta-blockers, 2024 Kayser - Metoprolol/bisoprolol, 2020 Orbach - Atenolol, 2013 Su - Beta-blockers (Controls unexposed, sick) , 2013 Petersen - Beta-blockers, 2012 Ray - Beta-blockers, 2001 6 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 1.83[1.44; 2.31]8,8532,06262%NAVaclavik - Beta-blockers, 2024 Fitton - Beta-blockers (Controls unexposed, sick), 2020 Kayser - Metoprolol/bisoprolol, 2020 Orbach - Atenolol, 2013 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 6   - Only cardiac indications other than ...  - Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 1.95[1.02; 3.72]9213931%NABaard - Beta-blockers, 2020 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 4   - Only chronic hypertension indication  - Only chronic hypertension indication 1.86[1.27; 2.72]111,0855,17191%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Xiang - Labetalol, 2020 Su - Beta-blockers (Controls unexposed, sick) , 2013 Petersen - Beta-blockers, 2012 Ray - Beta-blockers, 2001 Lydakis - Atenolol, 1999 6   - Only chronic indication (hypertensi ...  - Only chronic indication (hypertension or cardiac) 1.34[0.99; 1.82]6,887453 -NADelteil - Beta-blockers, 2024 1 All studiesAll studies 1.78[1.49; 2.13]126,9177,82580%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Baard - Beta-blockers, 2020 Fitton - Beta-blockers (Controls unexposed, sick), 2020 Kayser - Metoprolol/bisoprolol, 2020 Xiang - Labetalol, 2020 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Orbach - Atenolol, 2013 Su - Beta-blockers (Controls unexposed, sick) , 2013 Petersen - Beta-blockers, 2012 Ray - Beta-blockers, 2001 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 170.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.44.01.7440.000Delteil - Beta-blockers, 2024Vaclavik - Beta-blockers, 2024Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022Baard - Beta-blockers, 2020Fitton - Beta-blockers (Controls unexposed, sick), 2020Kayser - Metoprolol/bisoprolol, 2020Xiang - Labetalol, 2020Gandjbakhch - Beta-blockers, 2018Ishibashi - Beta-blockers, 2017Tanaka - Beta-blockers, 2016Orbach - Atenolol, 2013Su - Beta-blockers (Controls unexposed, sick) , 2013Petersen - Beta-blockers, 2012Ray - Beta-blockers, 2001Lydakis - Atenolol, 1999Cruickshank - Labetalol, 1991Rosenfeld - Pindolol, 1986

Asymetry test p-value = 0.5467 (by Egger's regression)

slope=0.6782 (0.0918); intercept=-0.4830 (0.7832); t=0.6167; p=0.5467

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13448, 13509, 17151

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.27[1.95; 2.64]201,7057,26679%NADelteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Al Khalaf - Beta-blockers (Controls unexposed, disease free), 2022 Fitton - Beta-blockers (Controls unexposed, disease free), 2020 Kayser - Metoprolol/bisoprolol, 2020 Orbach - Atenolol, 2013 Su - Beta-blockers (Controls unexposed, disease free), 2013 Petersen - Beta-blockers, 2012 8 unexposed, sick controlsunexposed, sick controls 1.64[1.26; 2.14]2,2153,91069%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Baard - Beta-blockers, 2020 Fitton - Beta-blockers (Controls unexposed, sick), 2020 Xiang - Labetalol, 2020 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Su - Beta-blockers (Controls unexposed, sick) , 2013 Ray - Beta-blockers, 2001 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 120.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Al Khalaf (Preterm birth)Al Khalaf (Preterm birth) 2.74[1.40; 5.36]-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT2 Bone - GESTATIONAL HYPERTENSION (Preterm birth)Bone - GESTATIONAL HYPERTENSION (Preterm birth) 0.98[0.45; 2.20]28%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bone - GESTATIONAL HYPERTENSION (Preterm birth)Bone - GESTATIONAL HYPERTENSION (Preterm birth) 0.83[0.37; 1.80]34%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Abalos (Preterm birth (< 37 weeks) (RCT versu ...Abalos (Preterm birth (< 37 weeks) (RCT versus no antihypertensive drugs/placebo)) 0.90[0.61; 1.32]0%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT4 Bellos - Atenolol (Preterm birth (Randomized ...Bellos - Atenolol (Preterm birth (Randomized controlled trial and Cohort studies)) 1.30[0.43; 3.92]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Labetalol (Preterm birth (Randomized ...Bellos - Labetalol (Preterm birth (Randomized controlled trial and Cohort studies)) 0.66[0.24; 1.76]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Labetalol (Preterm birth (Randomized ...Bellos - Labetalol (Preterm birth (Randomized controlled trial only)) 0.70[0.29; 1.70]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Magee (Preterm delivery)Magee (Preterm delivery) 1.00[0.76; 1.30]0%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT8 Magee (Preterm delivery)Magee (Preterm delivery) 0.81[0.52; 1.24]49%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT4 metaPregmetaPreg 1.78[1.49; 2.13]80%7,825----Delteil - Beta-blockers, 2024 Vaclavik - Beta-blockers, 2024 Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Baard - Beta-blockers, 2020 Fitton - Beta-blockers (Controls unexposed, sick), 2020 Kayser - Metoprolol/bisoprolol, 2020 Xiang - Labetalol, 2020 Gandjbakhch - Beta-blockers, 2018 Ishibashi - Beta-blockers, 2017 Tanaka - Beta-blockers, 2016 Orbach - Atenolol, 2013 Su - Beta-blockers (Controls unexposed, sick) , 2013 Petersen - Beta-blockers, 2012 Ray - Beta-blockers, 2001 Lydakis - Atenolol, 1999 Cruickshank - Labetalol, 1991 Rosenfeld - Pindolol, 1986 170.510.01.0