Atypical antipsychotics (Second generation) updated on 06-10-2025

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.
S18401
R77649
Kernizan (Controls exposed to LTG), 2024 C-section delivery during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick excluded Adjustment: No 1.20 [0.32;4.51] C
excluded (control group)
16/46   4/13 20 46
ref
S18348
R77612
Kernizan (Controls unexposed, sick), 2024 C-section delivery during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 1.04 [0.52;2.10] C 16/46   47/139 63 46
ref
S18338
R77579
Kulkarni - Quetiapine, 2024 Cesarean delivery at least 1st trimester excluded prospective cohort unexposed, sick Adjustment: No 1.87 [0.67;5.21] C
excluded (exposition period)
24/44   9/23 33 44
ref
S3851
R8194
Ellfolk (Control exposed to FGA), 2019 Cesarean section during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: Yes 1.25 [1.03;1.51]
excluded (control group)
1,057/4,225   336/1,576 1,393 4,225
ref
S3818
R8129
Ellfolk (Control unexposed), 2019 Cesarean section during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes 1.35 [1.18;1.53] 1,057/4,225   3,251/21,125 4,308 4,225
ref
S3905
R8275
Schaffer (Controls unexposed, NOS), 2019 Caesarean section during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: No 1.36 [1.21;1.53] C
excluded (control group)
415/1,322   34,004/135,200 34,419 1,322
ref
S3907
R8284
Schaffer (Controls unexposed, sick), 2019 Caesarean section during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No 1.24 [1.05;1.46] C 415/1,322   383/1,419 798 1,322
ref
S2336
R3009
Petersen (Control discontinued treatment before pregnancy), 2016 Caesarean section 1st trimester excluded retrospective cohort (claims database) unexposed, sick Adjustment: No 1.15 [0.78;1.68] C
excluded (exposition period)
69/280   67/302 136 280
ref
S3847
R8171
Petersen (Control exposed to FGA), 2016 Caesarean section 1st trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No 0.90 [0.57;1.40] C
excluded (control group)
69/280   42/157 111 280
ref
S2398
R3010
Petersen (Control unexposed, disease free), 2016 Caesarean section 1st trimester retrospective cohort (claims database) unexposed, disease free excluded Adjustment: No 1.45 [1.11;1.91] C
excluded (control group)
69/280   58,532/318,434 58,601 280
ref
S2294
R8214
Vigod, 2015 Caesarean section during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes Matched 0.97 [0.82;1.13] 317/1,021   325/1,021 642 1,021
ref
S2332
R8153
Peng, 2013 Caesarean throughout pregnancy prospective cohort unexposed, disease free Adjustment: No Matched 1.70 [0.90;3.24] C 40/76   30/76 70 76
ref
S2286
R8151
Sadowski, 2013 C-section (repeat, emergency and schedules) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: No Matched 1.48 [0.82;2.66] C 35/113   27/116 62 113
ref
S3842
R8161
Hironaka (Control exposed to BZD), 2011 Emergency cesarean section during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick excluded Adjustment: No 1.80 [0.06;54.33] C
excluded (control group)
1/9   0/5 1 9
ref
S2334
R3595
Hironaka (Control unexposed, disease free), 2011 Emergency cesarean section during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free excluded Adjustment: No 2.19 [0.26;18.68] C
excluded (control group)
1/9   15/278 16 9
ref
S14447
R57311
Hironaka (Control unexposed, sick), 2011 Emergency cesarean section during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 1.00 [0.03;33.32] C 1/9   0/3 1 9
ref
Total 7 studies 1.21 [1.04;1.41] 5,944 6,812
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 Kernizan (Controls unexposed, sick), 2024Kernizan, 2024 1 1.04[0.52; 2.10]63464%ROB confusion: unclearROB selection: unclearROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: critical Ellfolk (Control unexposed), 2019Ellfolk, 2019 2 1.35[1.18; 1.53]4,3084,22531%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: low Schaffer (Controls unexposed, sick), 2019Schaffer, 2019 3 1.24[1.05; 1.46]7981,32227%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Vigod, 2015Vigod, 2015 0.97[0.82; 1.13]6421,02127%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Peng, 2013Peng, 2013 1.70[0.90; 3.24]70765%ROB confusion: seriousROB selection: unclearROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Sadowski, 2013Sadowski, 2013 1.48[0.82; 2.66]621136%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Hironaka (Control unexposed, sick), 2011Hironaka, 2011 4 1.00[0.03; 33.32]190%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Total (7 studies) I2 = 49% 1.21[1.04; 1.41]5,9446,8120.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Control unexposed; 3: Controls unexposed, sick; 4: Control unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.21[1.04; 1.41]5,9446,81249%NAKernizan (Controls unexposed, sick), 2024 Ellfolk (Control unexposed), 2019 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 Peng, 2013 Sadowski, 2013 Hironaka (Control unexposed, sick), 2011 7 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.37[1.21; 1.55]4,4404,4140%NAEllfolk (Control unexposed), 2019 Peng, 2013 Sadowski, 2013 3 unexposed, sickunexposed, sick 1.09[0.92; 1.29]1,5042,39831%NAKernizan (Controls unexposed, sick), 2024 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 Hironaka (Control unexposed, sick), 2011 4 Tags Adjustment   - No  - No 1.26[1.09; 1.47]9941,5660%NAKernizan (Controls unexposed, sick), 2024 Schaffer (Controls unexposed, sick), 2019 Peng, 2013 Sadowski, 2013 Hironaka (Control unexposed, sick), 2011 5   - Yes  - Yes 1.15[0.83; 1.59]4,9505,24690%NAEllfolk (Control unexposed), 2019 Vigod, 2015 2 MatchedMatched 1.22[0.83; 1.78]7741,21054%NAVigod, 2015 Peng, 2013 Sadowski, 2013 3 All studiesAll studies 1.21[1.04; 1.41]5,9446,81249%NAKernizan (Controls unexposed, sick), 2024 Ellfolk (Control unexposed), 2019 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 Peng, 2013 Sadowski, 2013 Hironaka (Control unexposed, sick), 2011 70.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.24.42.1470.000Kernizan (Controls unexposed, sick), 2024Ellfolk (Control unexposed), 2019Schaffer (Controls unexposed, sick), 2019Vigod, 2015Peng, 2013Sadowski, 2013Hironaka (Control unexposed, sick), 2011

Asymetry test p-value = 0.8555 (by Egger's regression)

slope=0.1731 (0.1071); intercept=0.1814 (0.9463); t=0.1917; p=0.8555

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 3842, 2334, 3847, 2398, 3851, 3905, 18401

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.37[1.25; 1.49]38,8755,7450%NAEllfolk (Control unexposed), 2019 Schaffer (Controls unexposed, NOS), 2019 Peng, 2013 Sadowski, 2013 Hironaka (Control unexposed, disease free), 2011 5 unexposed, sick controlsunexposed, sick controls 1.09[0.92; 1.29]1,5042,39831%NAKernizan (Controls unexposed, sick), 2024 Schaffer (Controls unexposed, sick), 2019 Vigod, 2015 Hironaka (Control unexposed, sick), 2011 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.25[1.04; 1.51]1,4144,2800%NAKernizan (Controls exposed to LTG), 2024 Ellfolk (Control exposed to FGA), 2019 Hironaka (Control exposed to BZD), 2011 30.510.01.0