Carbamazepine (Epilepsy) updated on 04-22-2025

ADHD (Attention deficit hyperactivity disorder): Diagnosis/Risk

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.
S19457
R82946
Straub (Controls exposed to LTG) (Carbamazepine) (Epilepsy), 2026 Attention deficit hyperactivity disorder (ADHD) - ICD-10 codes: F90.x - Mean follow up (full cohort): 3.4 years during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No 2.31 [1.75;3.05] C
excluded (control group)
107/1,548   102/3,273 209 1,548
ref
S19467
R83023
Straub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026 Attention deficit hyperactivity disorder (ADHD) - ICD-10 codes: F90.x - Mean follow up (full cohort): 3.4 years during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes 1.13 [0.89;1.43] 107/1,548   366/8,887 473 1,548
ref
S17426
R73195
Madley-Dowd_SE (Carbamazepine) (Controls exposed to LTG), 2024 Attention Deficit Hyperactivity Disorder - ICD-8/9/10 codes and/or ADHD medication prescription - Mean 5-20 years old (according groups) during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No Partial overlapping 2.40 [1.88;3.06] C
excluded (control group)
190/1,842   109/2,383 299 1,842
ref
S17427
R73196
Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024 Attention Deficit Hyperactivity Disorder - ICD-8/9/10 codes and/or ADHD medication prescription - Mean 5-20 years old (according groups) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes Partial overlapping 1.00 [0.85;1.18] 190/1,842   929/10,769 1,119 1,842
ref
S17257
R72271
Madley-Dowd_UK (Carbamazepine) (Controls exposed to LTG), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median CBZ 9.17 (5.31-12.54) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No 1.36 [0.61;3.02] C
excluded (control group)
11/460   14/791 25 460
ref
S17107
R72272
Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median CBZ 9.17 (5.31-12.54) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes 2.29 [1.14;4.60] 11/460   38/4,075 49 460
ref
S15868
R65361
Dreier (Carbamazepine) (Epilepsy) (Controls exposed to LTG), 2023 Attention-deficit/hyperactivity disorder (ADHD) - Corresponding ICD-10 F-chapter - Up to 22 years of age during pregnancy (anytime or not specified) population based cohort propective exposed to other treatment, sick excluded Adjustment: No 1.89 [1.41;2.53] C
excluded (control group)
89/2,665   95/5,288 184 2,665
ref
S15869
R65377
Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Attention-deficit/hyperactivity disorder (ADHD) - Corresponding ICD-10 F-chapter - Up to 22 years of age during pregnancy (anytime or not specified) population based cohort propective unexposed, sick Adjustment: Yes 1.05 [0.81;1.37] 89/2,665   528/22,203 617 2,665
ref
S7510
R46610
Huber-Mollema (Carbamazepine), 2019 Diagnosis of ADHD throughout pregnancy prospective cohort exposed to other treatment, sick Adjustment: No 0.95 [0.18;5.12] C 2/37   5/88 7 37
ref
S6661
R46606
Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 Attention deficit hyperactivity disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 1.82 [0.07;46.28] C
excluded (control group)
1/50   0/30 1 50
ref
S6660
R46607
Bromley (Carbamazepine) (Controls unexposed, disease free), 2013 Attention deficit hyperactivity disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 13.21 [0.53;329.15] C
excluded (control group)
1/50   0/214 1 50
ref
S5486
R46608
Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Attention deficit hyperactivity disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 1.58 [0.06;40.13] C 1/50   0/26 1 50
ref
S5542
R46609
Cohen (Carbamazepine), 2013 Children with either ADHD inattentive OR combined types > 1 SD (from the Attention Problems and Hyperactivity scales of the BASC) (Both Parent and Teacher) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 0.96 [0.22;4.25] C 4/32   4/31 8 32
ref
S6356
R46612
Veiby (Carbamazepine) (Controls exposed to Lamotrigine, sick) b, 2013 ADHD symptoms ≥ 2SD (at 36 months) (Specific checklist) (Parent-reported) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 0.94 [0.15;6.00] C
excluded (control group)
2/31   3/44 5 31
ref
S6354
R46613
Veiby (Carbamazepine) (Controls unexposed, disease free) b, 2013 ADHD symptoms ≥ 2SD (at 36 months) (Specific checklist) (Parent-reported) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 2.00 [0.50;8.60]
excluded (control group)
2/31   1,743/43,571 1,745 31
ref
S6355
R46614
Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 ADHD symptoms ≥ 2SD (at 36 months) (Specific checklist) (Parent-reported) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 2.59 [0.45;14.78] C 2/31   4/154 6 31
ref
S5831
R46615
Viinikainen (Carbamazepine) b, 2006 Conners' Teacher Rating Scale Global Index scores >1 SD throughout pregnancy prospective cohort unexposed, sick Adjustment: No 0.15 [0.01;3.50] C 0/12   2/11 2 12
ref
Total 9 studies 1.07 [0.95;1.20] 2,282 6,677
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 Straub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026Straub, 2026 1 1.13[0.89; 1.43]4731,54825%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: criticalROB reporting: moderate Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024Madley-Dowd_SE, 2024 2 1.00[0.85; 1.18]1,1191,84251%ROB confusion: moderateROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024Madley-Dowd_UK, 2024 3 2.29[1.14; 4.60]494603%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023Dreier, 2023 4 1.05[0.81; 1.37]6172,66520%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Huber-Mollema (Carbamazepine), 2019Huber-Mollema, 2019 5 0.95[0.18; 5.12]7370%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Bromley (Carbamazepine) (Controls unexposed, sick), 2013Bromley, 2013 6 1.58[0.06; 40.13]1500%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Cohen (Carbamazepine), 2013Cohen, 2013 7 0.96[0.22; 4.25]8321%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: criticalROB mesure: lowROB reporting: low Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013Veiby, 2013 8 2.59[0.45; 14.78]6310%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Viinikainen (Carbamazepine) b, 2006Viinikainen, 2006 9 0.15[0.01; 3.50]2120%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: moderateROB mesure: lowROB reporting: moderate Total (9 studies) I2 = 0% 1.07[0.95; 1.20]2,2826,6770.010.01.0ROB: A: confounding, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick) (Carbamazepine) (Epilepsy; 2: Carbamazepine) (Controls unexposed, sick; 3: Carbamazepine) (Controls unexposed, sick; 4: Carbamazepine) (Epilepsy) (Controls unexposed, sick; 5: Carbamazepine; 6: Carbamazepine) (Controls unexposed, sick; 7: Carbamazepine; 8: Carbamazepine) (Controls unexposed, sick) ; 9: Carbamazepine) ;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.07[0.95; 1.20]2,2826,6770%NAStraub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026 Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Huber-Mollema (Carbamazepine), 2019 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 9 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 1.10[0.93; 1.30]2,2676,60825%NAStraub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026 Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 7 exposed to other treatment, sickexposed to other treatment, sick 0.96[0.31; 2.92]15690%NAHuber-Mollema (Carbamazepine), 2019 Cohen (Carbamazepine), 2013 2 Tags Adjustment   - No  - No 1.10[0.46; 2.62]241620%NAHuber-Mollema (Carbamazepine), 2019 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 5   - Yes  - Yes 1.10[0.92; 1.32]2,2586,51545%NAStraub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026 Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 4 Partial overlappingPartial overlapping 1.00[0.85; 1.18]1,1191,842 -NAMadley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024 1 All studiesAll studies 1.07[0.95; 1.20]2,2826,6770%NAStraub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026 Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Huber-Mollema (Carbamazepine), 2019 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 90.010.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.93.91.9810.000Straub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023Huber-Mollema (Carbamazepine), 2019Bromley (Carbamazepine) (Controls unexposed, sick), 2013Cohen (Carbamazepine), 2013Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013Viinikainen (Carbamazepine) b, 2006

Asymetry test p-value = 0.5288 (by Egger's regression)

slope=0.0239 (0.0874); intercept=0.3230 (0.4875); t=0.6626; p=0.5288

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 6661, 6660, 6356, 6354, 15868, 17426, 17257, 19457

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.90[0.67; 12.58]1,7468110%NABromley (Carbamazepine) (Controls unexposed, disease free), 2013 Veiby (Carbamazepine) (Controls unexposed, disease free) b, 2013 2 unexposed, sick controlsunexposed, sick controls 1.10[0.93; 1.30]2,2676,60825%NAStraub (Controls unexposed, sick) (Carbamazepine) (Epilepsy), 2026 Madley-Dowd_SE (Carbamazepine) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Carbamazepine) (Controls unexposed, sick), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls unexposed, sick), 2023 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Veiby (Carbamazepine) (Controls unexposed, sick) b, 2013 Viinikainen (Carbamazepine) b, 2006 7 exposed to other treatment, sick controlsexposed to other treatment, sick controls 2.13[1.83; 2.48]7386,6650%NAStraub (Controls exposed to LTG) (Carbamazepine) (Epilepsy), 2026 Madley-Dowd_SE (Carbamazepine) (Controls exposed to LTG), 2024 Madley-Dowd_UK (Carbamazepine) (Controls exposed to LTG), 2024 Dreier (Carbamazepine) (Epilepsy) (Controls exposed to LTG), 2023 Huber-Mollema (Carbamazepine), 2019 Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 Cohen (Carbamazepine), 2013 Veiby (Carbamazepine) (Controls exposed to Lamotrigine, sick) b, 2013 80.510.01.0