Proton Pump Inhibitors updated on 08-09-2023

Major congenital malformations

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.
S14453
R57351		 Choi a, 2023 Major congenital malformations 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes 1.07 [1.02;1.13] 1,608/40,540   85,900/2,655,676 87,508 40,540
ref
S4446
R10559		 Matok, 2012 Major malformations (according to CDC definitions) 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes 1.06 [0.84;1.33] 80/1,186   6,425/109,597 6,505 1,186
ref
S4442
R10696		 Bànhidy - Omeprazole, 2011 Congenital abnormalities during pregnancy (anytime or not specified) excluded case control unexposed (general population or NOS) Adjustment: No Matched 1.23 [1.02;1.47] C
excluded (exposition period) 		206/487   22,637/60,507 22,843 487
ref
S4881
R12842		 Colvin, 2011 Major birth defects 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No 1.20 [0.80;2.00] 18/360   3,953/98,825 3,971 360
ref
S4275
R10431		 Pasternak, 2010 Major birth defects (Exposure during First Trimester) 1st trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes 1.10 [0.91;1.34] 118/3,651   21,867/837,317 21,985 3,651
ref
S4428
R10466		 Diav-Citrin, 2005 Major anomalies 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No 1.04 [0.51;2.10] C 11/280   30/792 41 280
ref
S4883
R13158		 Moretti, 2002 Major malformations at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No 1.19 [0.17;8.21] 2/63   2/75 4 63
ref
S4293
R10017		 Lalkin - Omeprazole (Controls exposed to other treatment, sick), 1998 Major malformations 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No Matched 1.71 [0.37;7.89] C
excluded (control group) 		4/78   3/98 7 78
ref
S4407
R10425		 Lalkin - Omeprazole (Controls unexposed NOS), 1998 Major malformations 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Matched 1.73 [0.31;9.76] C 4/78   2/66 6 78
ref
Total 7 studies 1.07 [1.02;1.13] 120,020 46,158
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 Choi a, 2023Choi a, 2023 1.07[1.02; 1.13]87,50840,54088%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: NAROB reporting: NA Matok, 2012Matok, 2012 1.06[0.84; 1.33]6,5051,1864%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Colvin, 2011Colvin, 2011 1.20[0.80; 2.00]3,9713601%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: unclearROB reporting: moderate Pasternak, 2010Pasternak, 2010 1.10[0.91; 1.34]21,9853,6516%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Diav-Citrin, 2005Diav-Citrin, 2005 1.04[0.51; 2.10]412800%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Moretti, 2002Moretti, 2002 1.19[0.17; 8.21]4630%ROB confusion: unclearROB selection: unclearROB classification: unclearROB missing: unclearROB mesure: unclearROB reporting: unclear Lalkin - Omeprazole (Controls unexposed NOS), 1998Lalkin - Omeprazole, 1998 1 1.73[0.31; 9.76]6780%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Total (7 studies) I2 = 0% 1.07[1.02; 1.13]120,02046,1580.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.07[1.02; 1.13]120,02046,1580%NAChoi a, 2023 Matok, 2012 Colvin, 2011 Pasternak, 2010 Diav-Citrin, 2005 Moretti, 2002 Lalkin - Omeprazole (Controls unexposed NOS), 1998 7 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.10[0.95; 1.26]32,5125,6180%NAMatok, 2012 Colvin, 2011 Pasternak, 2010 Diav-Citrin, 2005 Moretti, 2002 Lalkin - Omeprazole (Controls unexposed NOS), 1998 6 unexposed, sickunexposed, sick 1.07[1.02; 1.13]87,50840,540 -NAChoi a, 2023 1 Tags Adjustment   - No  - No 1.17[0.81; 1.69]4,0227810%NAColvin, 2011 Diav-Citrin, 2005 Moretti, 2002 Lalkin - Omeprazole (Controls unexposed NOS), 1998 4   - Yes  - Yes 1.07[1.02; 1.12]115,99845,3770%NAChoi a, 2023 Matok, 2012 Pasternak, 2010 3 MatchedMatched 1.73[0.31; 9.76]678 -NALalkin - Omeprazole (Controls unexposed NOS), 1998 1 All studiesAll studies 1.07[1.02; 1.13]120,02046,1580%NAChoi a, 2023 Matok, 2012 Colvin, 2011 Pasternak, 2010 Diav-Citrin, 2005 Moretti, 2002 Lalkin - Omeprazole (Controls unexposed NOS), 1998 70.55.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.32.41.1870.000Choi a, 2023Matok, 2012Colvin, 2011Pasternak, 2010Diav-Citrin, 2005Moretti, 2002Lalkin - Omeprazole (Controls unexposed NOS), 1998

Asymetry test p-value = 0.1164 (by Egger's regression)

slope=0.0608 (0.0084); intercept=0.2447 (0.1290); t=1.8965; p=0.1164

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 4293

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.10[0.95; 1.26]32,5125,6180%NAMatok, 2012 Colvin, 2011 Pasternak, 2010 Diav-Citrin, 2005 Moretti, 2002 Lalkin - Omeprazole (Controls unexposed NOS), 1998 6 unexposed, sick controlsunexposed, sick controls 1.07[1.02; 1.13]87,50840,540 -NAChoi a, 2023 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.71[0.37; 7.89]778 -NALalkin - Omeprazole (Controls exposed to other treatment, sick), 1998 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Li (Congenital malformations overall includin ...Li (Congenital malformations overall including continuity correction) 1.28[1.09; 1.52]26-Anyduring pregnancy (anytime or not specified)studies TTT18 Gill (Major congenital malformations)Gill (Major congenital malformations) 1.12[0.86; 1.45]0-T11st trimesterstudies TTT7 Nikfar (Major malformations)Nikfar (Major malformations) 1.18[0.72; 1.94]-T11st trimesterstudies TTT5 metaPregmetaPreg 1.07[1.02; 1.13]0%46,158----Choi a, 2023 Matok, 2012 Colvin, 2011 Pasternak, 2010 Diav-Citrin, 2005 Moretti, 2002 Lalkin - Omeprazole (Controls unexposed NOS), 1998 70.510.01.0