Calcium channel blockers (versus unexposed)

Small for gestational age (weight)

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.
S13513
R52200
Fitton - Calcium blockers (Controls unexposed, disease free), 2020 Small for gestational age (birth weight below the 10th percentile) 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 1.24 [0.64;2.39]
excluded (control group)
18/167   24,121/250,693 24,139 167
ref
S14422
R57252
Fitton - Calcium blockers (Controls unexposed, sick), 2020 Small for gestational age (birth weight below the 10th percentile) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 0.79 [0.48;1.29] C 18/167   1,059/7,971 1,077 167
ref
S13922
R54506
Fisher b - Calcium inhibitors (Controls unexposed, disease free), 2018 Small for gestational age (birthweight < 10th percentile for a given gestational age in weeks, sex, race/ethnicity, and parity) during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free excluded Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 1.98 [0.37;7.01]
excluded (control group)
3/18   923/9,219 926 18
ref
S13923
R54507
Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Small for gestational age (birthweight < 10th percentile for a given gestational age in weeks, sex, race/ethnicity, and parity) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 1.46 [0.42;5.14] C 3/18   101/839 104 18
ref
S13449
R51812
Su - Calcium blockers (Controls unexposed, disease free), 2013 Small for gestational age (<10th percentile for gestational age and gender) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 1.79 [1.37;2.34] C
excluded (control group)
74/303   1,250/8,181 1,324 303
ref
S13443
R51794
Su - Calcium blockers (Controls unexposed, sick), 2013 Small for gestational age (<10th percentile for gestational age and gender) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication 1.45 [1.06;1.97] 74/303   184/1,006 258 303
ref
S13469
R51950
Nakhai-Pour - Calcium blockers, 2010 Small for gestational age (a birth weight less than the 10th percentile for that gestational age and gender) 2nd and/or 3rd trimester nested case control unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.19 [0.09;53.74] C 0/1   7,445/56,333 7,445 1
ref
S13789
R54071
Bayliss - Calcium blockers, 2002 Small for gestational age (birth weight for gestation on or below the 10th percentile using Gairdner– Pearson growth charts) throughout pregnancy retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 0.68 [0.18;2.54] C 3/14   49/171 52 14
ref
S13988
R54962
Magee - Calcium blockers, 1996 Small for gestational age (NOS) at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified Matched 4.49 [0.49;41.36] C 4/61   1/65 5 61
ref
Total 6 studies 1.17 [0.81;1.70] 8,941 564
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 Fitton - Calcium blockers (Controls unexposed, sick), 2020Fitton - Calcium blockers, 2020 1 0.79[0.48; 1.29]1,07716732%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: moderateROB mesure: moderateROB reporting: moderate Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018Fisher b - Calcium inhibitors, 2018 2 1.46[0.42; 5.14]104188%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Su - Calcium blockers (Controls unexposed, sick), 2013Su - Calcium blockers, 2013 3 1.45[1.06; 1.97]25830349%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Nakhai-Pour - Calcium blockers, 2010Nakhai-Pour - Calcium blockers, 2010 2.19[0.09; 53.74]7,44511%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Bayliss - Calcium blockers, 2002Bayliss - Calcium blockers, 2002 0.68[0.18; 2.54]52147%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Magee - Calcium blockers, 1996Magee - Calcium blockers, 1996 4.49[0.49; 41.36]5613%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: criticalROB reporting: moderate Total (6 studies) I2 = 23% 1.17[0.81; 1.70]8,9415640.210.01.0ROB: 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 1.15[0.76; 1.76]1,49656337%NAFitton - Calcium blockers (Controls unexposed, sick), 2020 Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Su - Calcium blockers (Controls unexposed, sick), 2013 Bayliss - Calcium blockers, 2002 Magee - Calcium blockers, 1996 5 case control studiescase control studies 2.19[0.09; 53.74]7,4451 -NANakhai-Pour - Calcium blockers, 2010 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 3.56[0.57; 22.04]7,450620%NANakhai-Pour - Calcium blockers, 2010 Magee - Calcium blockers, 1996 2 unexposed, sickunexposed, sick 1.10[0.73; 1.67]1,49150240%NAFitton - Calcium blockers (Controls unexposed, sick), 2020 Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Su - Calcium blockers (Controls unexposed, sick), 2013 Bayliss - Calcium blockers, 2002 4 Tags Adjustment   - No  - No 0.90[0.59; 1.38]8,6832610%NAFitton - Calcium blockers (Controls unexposed, sick), 2020 Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Nakhai-Pour - Calcium blockers, 2010 Bayliss - Calcium blockers, 2002 Magee - Calcium blockers, 1996 5   - Yes  - Yes 1.45[1.06; 1.98]258303 -NASu - Calcium blockers (Controls unexposed, sick), 2013 1 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 0.97[0.59; 1.60]8,6312474%NAFitton - Calcium blockers (Controls unexposed, sick), 2020 Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Nakhai-Pour - Calcium blockers, 2010 Magee - Calcium blockers, 1996 4   - Only chronic hypertension indication  - Only chronic hypertension indication 1.32[0.80; 2.16]31031717%NASu - Calcium blockers (Controls unexposed, sick), 2013 Bayliss - Calcium blockers, 2002 2 MatchedMatched 4.49[0.49; 41.36]561 -NAMagee - Calcium blockers, 1996 1 All studiesAll studies 1.17[0.81; 1.70]8,94156423%NAFitton - Calcium blockers (Controls unexposed, sick), 2020 Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Su - Calcium blockers (Controls unexposed, sick), 2013 Nakhai-Pour - Calcium blockers, 2010 Bayliss - Calcium blockers, 2002 Magee - Calcium blockers, 1996 60.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.84.01.9600.000Fitton - Calcium blockers (Controls unexposed, sick), 2020Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018Su - Calcium blockers (Controls unexposed, sick), 2013Nakhai-Pour - Calcium blockers, 2010Bayliss - Calcium blockers, 2002Magee - Calcium blockers, 1996

Asymetry test p-value = 0.9315 (by Egger's regression)

slope=0.1873 (0.2550); intercept=0.0747 (0.8170); t=0.0915; p=0.9315

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13449, 13922, 13513

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.73[1.36; 2.21]33,8395500%NAFitton - Calcium blockers (Controls unexposed, disease free), 2020 Fisher b - Calcium inhibitors (Controls unexposed, disease free), 2018 Su - Calcium blockers (Controls unexposed, disease free), 2013 Nakhai-Pour - Calcium blockers, 2010 Magee - Calcium blockers, 1996 5 unexposed, sick controlsunexposed, sick controls 1.10[0.73; 1.67]1,49150240%NAFitton - Calcium blockers (Controls unexposed, sick), 2020 Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Su - Calcium blockers (Controls unexposed, sick), 2013 Bayliss - Calcium blockers, 2002 40.510.01.0

Umbrella review (other published meta-analyses)

Published MATE95% CIn exposedkI2Control groupExposition period AbalosAbalos 0.83[0.60; 1.16]0%-unexposed, sickduring pregnancy (anytime or not specified)studies3 Bellos - AmlodipineBellos - Amlodipine 2.00[0.17; 24.07]NA-unexposed, sickduring pregnancy (anytime or not specified)studies-9 Bellos - AmlodipineBellos - Amlodipine 0.65[0.25; 1.64]NA-unexposed, sickduring pregnancy (anytime or not specified)studies-9 Bellos - NifedipineBellos - Nifedipine 1.28[0.79; 2.09]NA-unexposed, sickduring pregnancy (anytime or not specified)studies-9 Bellos - NifedipineBellos - Nifedipine 1.85[0.93; 3.67]NA-unexposed, sickduring pregnancy (anytime or not specified)studies-9 Bone - GESTATIONAL HYPERTENSIONBone - GESTATIONAL HYPERTENSION 0.85[0.46; 1.56]22%-unexposed, sickduring pregnancy (anytime or not specified)studies-9 Bone - GESTATIONAL HYPERTENSIONBone - GESTATIONAL HYPERTENSION Out of scale0.36[0.03; 2.85]34%-exposed to other treatment, sickduring pregnancy (anytime or not specified)studies-9 Bone - GESTATIONAL HYPERTENSIONBone - GESTATIONAL HYPERTENSION 1.06[0.34; 3.19]33%-exposed to other treatment, sickduring pregnancy (anytime or not specified)studies-9 metaPregmetaPreg 1.17[0.81; 1.70]23%564--Fitton - Calcium blockers (Controls unexposed, sick), 2020 Fisher b - Calcium inhibitors (Controls unexposed, sick), 2018 Su - Calcium blockers (Controls unexposed, sick), 2013 Nakhai-Pour - Calcium blockers, 2010 Bayliss - Calcium blockers, 2002 Magee - Calcium blockers, 1996 60.510.01.0