Valproate (Epilepsy)

Low Apgar score (< 7) (at 5 min)

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.
S7460
R25138
Putignano (Valproate), 2019 Apgar score at 5 min < 7 during pregnancy (anytime or not specified) retrospective cohort unexposed (general population or NOS) Adjustment: No Matched 1.17 [0.14;9.78] C 1/131   6/917 7 131
ref
S5931
R15127
Artama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 5-min Apgar <7 3rd trimester population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 1.32 [0.34;5.19] C
excluded (control group)
7/235   3/132 10 235
ref
S5911
R14906
Artama (Valproate) (Controls unexposed, disease free), 2013 5-min Apgar <7 3rd trimester population based cohort retrospective unexposed, disease free excluded Adjustment: Yes 2.72 [1.28;5.81]
excluded (control group)
7/235   3,014/269,151 3,021 235
ref
S5919
R15002
Artama (Valproate) (Controls unexposed, sick), 2013 5-min Apgar <7 3rd trimester population based cohort retrospective unexposed, sick Adjustment: Yes 2.68 [0.91;7.94] 7/235   3/652 10 235
ref
S6353
R17320
Veiby (Valproate) (Controls exposed to Lamotrigine, sick) b, 2013 Low Apgar score (< 7 at 5 min) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 2.66 [0.36;19.54] C
excluded (control group)
2/40   2/103 4 40
ref
S5506
R17324
Veiby (Valproate) (Controls unexposed, disease free) b, 2013 Low Apgar score (< 7 at 5 min) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 1.60 [0.20;11.80]
excluded (control group)
2/40   1,710/106,899 1,712 40
ref
S6350
R17328
Veiby (Valproate) (Controls unexposed, sick) b, 2013 Low Apgar score (< 7 at 5 min) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 2.20 [0.46;10.58] C 2/40   9/386 11 40
ref
S6416
R17617
Pennell (Valproate), 2012 Apgar score (at 5 minutes < 7) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 8.11 [0.38;171.84] C 2/62   0/97 2 62
ref
S6261
R16734
Borthen (Valproate) (Controls exposed to Lamotrigine, sick), 2010 Apgar < 7 after 5 minutes during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 0.46 [0.12;1.79] C
excluded (control group)
3/215   7/233 10 215
ref
S5684
R16679
Borthen (Valproate) (Controls unexposed, disease free), 2010 Apgar < 7 after 5 minutes during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: Yes 1.00 [0.30;3.20]
excluded (control group)
3/215   6,022/362,302 6,025 215
ref
S6263
R16750
Borthen (Valproate) (Controls unexposed, sick), 2010 Apgar < 7 after 5 minutes during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No 0.86 [0.26;2.86] C 3/215   30/1,863 33 215
ref
S5495
R16633
Jäger-Roman (Valproate), 1986 Low Apgar score (0 to 6 after 5 minute) at least 1st trimester excluded prospective cohort unexposed (general population or NOS) Adjustment: No 11.09 [0.49;249.88] C
excluded (exposition period)
2/14   0/26 2 14
ref
Total 5 studies 1.78 [0.92;3.45] 63 683
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 Putignano (Valproate), 2019Putignano, 2019 1 1.17[0.14; 9.78]713110%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Artama (Valproate) (Controls unexposed, sick), 2013Artama, 2013 2 2.68[0.91; 7.94]1023537%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Veiby (Valproate) (Controls unexposed, sick) b, 2013Veiby, 2013 3 2.20[0.46; 10.58]114018%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Pennell (Valproate), 2012Pennell, 2012 4 8.11[0.38; 171.84]2625%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Borthen (Valproate) (Controls unexposed, sick), 2010Borthen, 2010 5 0.86[0.26; 2.86]3321531%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 0% 1.78[0.92; 3.45]636830.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Valproate; 2: Valproate) (Controls unexposed, sick; 3: Valproate) (Controls unexposed, sick) ; 4: Valproate; 5: Valproate) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.78[0.92; 3.45]636830%NAPutignano (Valproate), 2019 Artama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Pennell (Valproate), 2012 Borthen (Valproate) (Controls unexposed, sick), 2010 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.17[0.14; 9.78]7131 -NAPutignano (Valproate), 2019 1 unexposed, sickunexposed, sick 1.72[0.84; 3.52]544901%NAArtama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Borthen (Valproate) (Controls unexposed, sick), 2010 3 exposed to other treatment, sickexposed to other treatment, sick 8.11[0.38; 171.84]262 -NAPennell (Valproate), 2012 1 Tags Adjustment   - No  - No 1.40[0.61; 3.22]534480%NAPutignano (Valproate), 2019 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Pennell (Valproate), 2012 Borthen (Valproate) (Controls unexposed, sick), 2010 4   - Yes  - Yes 2.68[0.91; 7.92]10235 -NAArtama (Valproate) (Controls unexposed, sick), 2013 1 MatchedMatched 1.17[0.14; 9.78]7131 -NAPutignano (Valproate), 2019 1 All studiesAll studies 1.78[0.92; 3.45]636830%NAPutignano (Valproate), 2019 Artama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Pennell (Valproate), 2012 Borthen (Valproate) (Controls unexposed, sick), 2010 50.220.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.74.21.8700.000Putignano (Valproate), 2019Artama (Valproate) (Controls unexposed, sick), 2013Veiby (Valproate) (Controls unexposed, sick) b, 2013Pennell (Valproate), 2012Borthen (Valproate) (Controls unexposed, sick), 2010

Asymetry test p-value = 0.6039 (by Egger's regression)

slope=0.0324 (0.9967); intercept=0.7635 (1.3214); t=0.5778; p=0.6039

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 6261, 5684, 5931, 5911, 6353, 5506

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.91[1.07; 3.43]10,7656210%NAPutignano (Valproate), 2019 Artama (Valproate) (Controls unexposed, disease free), 2013 Veiby (Valproate) (Controls unexposed, disease free) b, 2013 Borthen (Valproate) (Controls unexposed, disease free), 2010 4 unexposed, sick controlsunexposed, sick controls 1.72[0.84; 3.52]544901%NAArtama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Borthen (Valproate) (Controls unexposed, sick), 2010 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.26[0.46; 3.46]2655226%NAArtama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 Veiby (Valproate) (Controls exposed to Lamotrigine, sick) b, 2013 Pennell (Valproate), 2012 Borthen (Valproate) (Controls exposed to Lamotrigine, sick), 2010 40.510.01.0