Calcium channel blockers (versus unexposed)

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.
S17161
R71973
Vaclavik - Amlodipine, 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 3.25 [2.58;4.09] -/90   -/71,860 - 90
ref
S17153
R71941
Al Khalaf - Calcium channel 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 2.95 [2.01;4.33] C
excluded (control group)
29/289   63,460/1,739,944 63,489 289
ref
S17150
R71920
Al Khalaf - Calcium channel 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 2.20 [1.61;3.02] C 50/289   677/7,809 727 289
ref
S13513
R52198
Fitton - Calcium 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 4.73 [2.90;7.71]
excluded (control group)
39/167   12,622/250,693 12,661 167
ref
S14422
R57250
Fitton - Calcium 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 3.00 [2.08;4.32] C 39/167   736/7,971 775 167
ref
S13387
R52258
Mito - Amlodipine, 2019 Preterm birth (<37 wks) at least 1st trimester retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 0.56 [0.26;1.24] C 10/48   41/129 51 48
ref
S13449
R51810
Su - Calcium 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 2.66 [1.92;3.67] C
excluded (control group)
47/303   529/8,181 576 303
ref
S13443
R51792
Su - Calcium 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 2.11 [1.43;3.10] 47/303   84/1,006 131 303
ref
S13987
R54924
Weber-Schoendorfer - Calcium blockers, 2008 Preterm children (<37 weeks) at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 4.63 [2.94;7.27] 54/227   47/722 101 227
ref
S13988
R54961
Magee - Calcium blockers, 1996 Delivery < 37 weeks at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched 4.01 [1.03;15.62] 18/64   6/71 24 64
ref
Total 7 studies 2.50 [1.79;3.51] 1,809 1,188
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 Vaclavik - Amlodipine, 2024Vaclavik - Amlodipine, 2024 3.25[2.58; 4.09]-9019%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: unclear Al Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022Al Khalaf - Calcium channel b..., 2022 1 2.20[1.61; 3.02]72728918%ROB confusion: criticalROB selection: unclearROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Fitton - Calcium blockers (Controls unexposed, sick), 2020Fitton - Calcium blockers, 2020 2 3.00[2.08; 4.32]77516717%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Mito - Amlodipine, 2019Mito - Amlodipine, 2019 0.56[0.26; 1.24]514810%ROB confusion: seriousROB selection: criticalROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Su - Calcium blockers (Controls unexposed, sick), 2013Su - Calcium blockers, 2013 3 2.11[1.43; 3.10]13130316%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Weber-Schoendorfer - Calcium blockers, 2008Weber-Schoendorfer - Calcium blockers, 2008 4.63[2.94; 7.27]10122715%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: unclearROB reporting: moderate Magee - Calcium blockers, 1996Magee - Calcium blockers, 1996 4.01[1.03; 15.62]24645%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: criticalROB reporting: moderate Total (7 studies) I2 = 78% 2.50[1.79; 3.51]1,8091,1880.210.01.0ROB: 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 2.50[1.79; 3.51]1,8091,18878%NAVaclavik - Amlodipine, 2024 Al Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022 Fitton - Calcium blockers (Controls unexposed, sick), 2020 Mito - Amlodipine, 2019 Su - Calcium blockers (Controls unexposed, sick), 2013 Weber-Schoendorfer - Calcium blockers, 2008 Magee - Calcium blockers, 1996 7 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 3.51[2.86; 4.30]1253810%NAVaclavik - Amlodipine, 2024 Weber-Schoendorfer - Calcium blockers, 2008 Magee - Calcium blockers, 1996 3 unexposed, sickunexposed, sick 1.89[1.20; 2.98]1,68480779%NAAl Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022 Fitton - Calcium blockers (Controls unexposed, sick), 2020 Mito - Amlodipine, 2019 Su - Calcium blockers (Controls unexposed, sick), 2013 4 Tags Adjustment   - No  - No 2.26[1.46; 3.48]1,57765880%NAVaclavik - Amlodipine, 2024 Al Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022 Fitton - Calcium blockers (Controls unexposed, sick), 2020 Mito - Amlodipine, 2019 Magee - Calcium blockers, 1996 5   - Yes  - Yes 3.10[1.43; 6.69]23253085%NASu - Calcium blockers (Controls unexposed, sick), 2013 Weber-Schoendorfer - Calcium blockers, 2008 2 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 3.38[2.83; 4.04]9005480%NAVaclavik - Amlodipine, 2024 Fitton - Calcium blockers (Controls unexposed, sick), 2020 Weber-Schoendorfer - Calcium blockers, 2008 Magee - Calcium blockers, 1996 4   - Only chronic hypertension indication  - Only chronic hypertension indication 1.55[0.86; 2.80]90964080%NAAl Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022 Mito - Amlodipine, 2019 Su - Calcium blockers (Controls unexposed, sick), 2013 3 MatchedMatched 4.01[1.03; 15.62]2464 -NAMagee - Calcium blockers, 1996 1 All studiesAll studies 2.50[1.79; 3.51]1,8091,18878%NAVaclavik - Amlodipine, 2024 Al Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022 Fitton - Calcium blockers (Controls unexposed, sick), 2020 Mito - Amlodipine, 2019 Su - Calcium blockers (Controls unexposed, sick), 2013 Weber-Schoendorfer - Calcium blockers, 2008 Magee - Calcium blockers, 1996 70.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.82.50.8320.000Vaclavik - Amlodipine, 2024Al Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022Fitton - Calcium blockers (Controls unexposed, sick), 2020Mito - Amlodipine, 2019Su - Calcium blockers (Controls unexposed, sick), 2013Weber-Schoendorfer - Calcium blockers, 2008Magee - Calcium blockers, 1996

Asymetry test p-value = 0.4466 (by Egger's regression)

slope=1.2952 (0.3778); intercept=-1.6355 (1.9808); t=0.8257; p=0.4466

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13449, 13513, 17153

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 3.36[2.80; 4.02]76,8511,14022%NAVaclavik - Amlodipine, 2024 Al Khalaf - Calcium channel blockers (Controls unexposed, disease free), 2022 Fitton - Calcium blockers (Controls unexposed, disease free), 2020 Su - Calcium blockers (Controls unexposed, disease free), 2013 Weber-Schoendorfer - Calcium blockers, 2008 Magee - Calcium blockers, 1996 6 unexposed, sick controlsunexposed, sick controls 1.89[1.20; 2.98]1,68480779%NAAl Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022 Fitton - Calcium blockers (Controls unexposed, sick), 2020 Mito - Amlodipine, 2019 Su - Calcium blockers (Controls unexposed, sick), 2013 40.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Bone - GESTATIONAL HYPERTENSION (Neonatal car ...Bone - GESTATIONAL HYPERTENSION (Neonatal care unit admission (versus Labetalol)) 1.36[0.45; 4.27]33%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bone - GESTATIONAL HYPERTENSION (Preterm birth)Bone - GESTATIONAL HYPERTENSION (Preterm birth) 1.06[0.76; 1.50]20%-U,Sunexposed, 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)) 1.01[0.86; 1.18]0%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT4 Bellos - Amlodipine (Preterm birth (Randomize ...Bellos - Amlodipine (Preterm birth (Randomized controlled trial and Cohort studies)) 0.75[0.22; 2.51]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Nifedipine (Preterm birth (Randomize ...Bellos - Nifedipine (Preterm birth (Randomized controlled trial and Cohort studies)) 1.50[0.52; 4.32]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Amlodipine (Preterm birth (Randomize ...Bellos - Amlodipine (Preterm birth (Randomized controlled trial only)) 1.50[0.19; 11.56]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Nifedipine (Preterm birth (Randomize ...Bellos - Nifedipine (Preterm birth (Randomized controlled trial only)) 1.06[0.50; 2.27]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bone - GESTATIONAL HYPERTENSION (Preterm birt ...Bone - GESTATIONAL HYPERTENSION (Preterm birth (versus Labetalol)) 1.64[0.69; 4.01]33%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bone - GESTATIONAL HYPERTENSION (Preterm birt ...Bone - GESTATIONAL HYPERTENSION (Preterm birth (versus methyldopa)) 0.51[0.15; 1.82]31%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 metaPregmetaPreg 2.50[1.79; 3.51]78%1,188----Vaclavik - Amlodipine, 2024 Al Khalaf - Calcium channel blockers (Controls unexposed, sick), 2022 Fitton - Calcium blockers (Controls unexposed, sick), 2020 Mito - Amlodipine, 2019 Su - Calcium blockers (Controls unexposed, sick), 2013 Weber-Schoendorfer - Calcium blockers, 2008 Magee - Calcium blockers, 1996 70.510.01.0