Tramadol (versus unexposed) updated on 07-09-2025

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.
S18427
R78022		 Ferrer, 2025 Circulatory system anomalies at least 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No 1.36 [0.61;3.04] C 6/999   677/152,811 683 999
ref
S13279
R51128		 Bowie, 2022 Cardiovascular anomaly at least 1st trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes 1.45 [0.63;3.31] 11/781   3,130/587,676 3,141 781
ref
S13280
R51155		 Sørensen, 2022 Heart malformations 1st trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes 1.03 [0.77;1.38] 55/3,796   213/15,111 268 3,796
ref
S13036
R49440		 Källén, 2015 Any cardiovascular defect early pregnancy population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes 1.56 [1.04;2.29] 26/1,776   17,117/1,797,678 17,143 1,776
ref
Total 4 studies 1.22 [0.98;1.52] 21,235 7,352
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 Ferrer, 2025Ferrer, 2025 1.36[0.61; 3.04]6839997%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Bowie, 2022Bowie, 2022 1.45[0.63; 3.31]3,1417817%ROB confusion: moderateROB selection: moderateROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Sørensen, 2022Sørensen, 2022 1.03[0.77; 1.38]2683,79655%ROB confusion: moderateROB selection: moderateROB classification: criticalROB missing: moderateROB mesure: moderateROB reporting: moderate Källén, 2015Källén, 2015 1.56[1.04; 2.29]17,1431,77630%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 1% 1.22[0.98; 1.52]21,2357,3520.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.22[0.98; 1.52]21,2357,3521%NAFerrer, 2025 Bowie, 2022 Sørensen, 2022 Källén, 2015 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.22[0.98; 1.52]21,2357,3521%NAFerrer, 2025 Bowie, 2022 Sørensen, 2022 Källén, 2015 4 Tags Adjustment   - No  - No 1.36[0.61; 3.04]683999 -NAFerrer, 2025 1   - Yes  - Yes 1.25[0.92; 1.69]20,5526,35332%NABowie, 2022 Sørensen, 2022 Källén, 2015 3 All studiesAll studies 1.22[0.98; 1.52]21,2357,3521%NAFerrer, 2025 Bowie, 2022 Sørensen, 2022 Källén, 2015 40.55.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.01.20.5080.000Ferrer, 2025Bowie, 2022Sørensen, 2022Källén, 2015

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

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.22[0.98; 1.52]21,2357,3521%NAFerrer, 2025 Bowie, 2022 Sørensen, 2022 Källén, 2015 40.510.01.0