Calcium channel blockers (versus unexposed)

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.
S13519
R52243
Fitton - Calcium Blockers, 2021 Circulatory defects (Q20-Q28) during pregnancy (anytime or not specified) excluded retrospective cohort (claims database) unexposed, disease free Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.46 [0.11;19.13]
excluded (exposition period)
-/-   873/252,598 - -
ref
S14252
R56029
Fisher - Calcium 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 1.41 [0.65;3.05]
excluded (control group)
18/29   10,607/21,733 10,625 29
ref
S14253
R56037
Fisher - Calcium 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 1.30 [0.59;2.86] 18/29   -/- - 29
ref
S13439
R51783
Lennestal - Calcium inhibitors, 2009 Any cardiovascular defect early pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.15 [0.24;3.35] 3/217   12,660/1,046,843 12,663 217
ref
S13996
R54983
Sorensen - Calcium blockers, 2001 Cardiovascular congenital abnormality 1st trimester case control unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 1.60 [0.80;3.20] 9/58   4,458/42,560 4,467 58
ref
Total 3 studies 1.42 [0.87;2.30] 17,130 304
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 Fisher - Calcium blockers (Controls unexposed, sick), 2017Fisher - Calcium blockers, 2017 1 1.30[0.59; 2.86]-2938%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Lennestal - Calcium inhibitors, 2009Lennestal - Calcium inhibitors, 2009 1.15[0.24; 3.35]12,66321714%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Sorensen - Calcium blockers, 2001Sorensen - Calcium blockers, 2001 1.60[0.80; 3.20]4,4675849%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Total (3 studies) I2 = 0% 1.42[0.87; 2.30]17,1303040.55.01.0ROB: 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 1.15[0.31; 4.30]12,663217 -NALennestal - Calcium inhibitors, 2009 1 case control studiescase control studies 1.46[0.87; 2.46]4,467870%NAFisher - Calcium blockers (Controls unexposed, sick), 2017 Sorensen - Calcium blockers, 2001 2 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.49[0.81; 2.75]17,1302750%NALennestal - Calcium inhibitors, 2009 Sorensen - Calcium blockers, 2001 2 unexposed, sickunexposed, sick 1.30[0.59; 2.86]-29 -NAFisher - Calcium blockers (Controls unexposed, sick), 2017 1 Tags Adjustment   - Yes  - Yes 1.42[0.87; 2.30]17,1303040%NAFisher - Calcium blockers (Controls unexposed, sick), 2017 Lennestal - Calcium inhibitors, 2009 Sorensen - Calcium blockers, 2001 3 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 1.42[0.87; 2.30]17,1303040%NAFisher - Calcium blockers (Controls unexposed, sick), 2017 Lennestal - Calcium inhibitors, 2009 Sorensen - Calcium blockers, 2001 3 All studiesAll studies 1.42[0.87; 2.30]17,1303040%NAFisher - Calcium blockers (Controls unexposed, sick), 2017 Lennestal - Calcium inhibitors, 2009 Sorensen - Calcium blockers, 2001 30.55.01.0

Publication bias and p-hacking diagnosis

funnel plot

Funnel plot not drawn. Less than 3 points.

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

not enought points

p values plot

Funnel plot not drawn. Less than 3 points.

Sub-groups analysis using all included studies

excluded 14252

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.46[0.90; 2.36]27,7553040%NAFisher - Calcium blockers (Controls unexposed, disease free), 2017 Lennestal - Calcium inhibitors, 2009 Sorensen - Calcium blockers, 2001 3 unexposed, sick controlsunexposed, sick controls 1.30[0.59; 2.86]-29 -NAFisher - Calcium blockers (Controls unexposed, sick), 2017 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Ramakrishnan (Congenital heart defects)Ramakrishnan (Congenital heart defects) 1.16[0.86; 1.55]NA-Wwhatever (meta-analysis)T11st trimesterstudies TTT3 metaPregmetaPreg 1.42[0.87; 2.30]0%304----Fisher - Calcium blockers (Controls unexposed, sick), 2017 Lennestal - Calcium inhibitors, 2009 Sorensen - Calcium blockers, 2001 30.510.01.0