Valproate (Epilepsy)

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.
S12546
R47236
Dreier (Valproate), 2021 Small for gestational age (birth weight below the 10th percentile for GA, sex and country) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes 1.09 [0.92;1.30] -/1,943   -/- - 1,943
ref
S8087
R24743
Aydin (Valproate) (Controls exposed to Lamotrigine, sick), 2020 Small for gestational age (birth weight) throughout pregnancy retrospective cohort exposed to other treatment, sick excluded Adjustment: No 0.62 [0.01;35.19] C
excluded (control group)
0/11   0/7 0 11
ref
S7922
R24605
Aydin (Valproate) (Controls unexposed, sick), 2020 Small for gestational age (birth weight) throughout pregnancy retrospective cohort unexposed, sick Adjustment: No 2.05 [0.04;110.56] C 0/11   0/22 0 11
ref
S7799
R23027
Coste (Valproate) (Controls unexposed, NOS), 2020 Small for gestational age (weight) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No 1.63 [1.37;1.94] C 149/991   167,376/1,710,441 167,525 991
ref
S8143
R25027
Cohen (Valproate) (Controls exposed to Lamotrigine, sick), 2019 Small for gestational age (ICD-9 656.5, 764.0, 764.1, 764.9) early pregnancy retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: Yes 1.55 [0.57;4.16]
excluded (control group)
-/-   -/- - -
ref
S8139
R24999
Cohen (Valproate) (Controls unexposed NOS), 2019 Small for gestational age (ICD-9 656.5, 764.0, 764.1, 764.9) early pregnancy retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes 0.97 [0.49;1.95] -/-   41,653/1,440,631 41,644 -
ref
S7460
R25139
Putignano (Valproate), 2019 Small for gestational age (SGA) (weight) during pregnancy (anytime or not specified) retrospective cohort unexposed (general population or NOS) Adjustment: No Matched 2.27 [1.35;3.79] C 22/131   75/917 97 131
ref
S5931
R15133
Artama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 Small for gestational age (weight) during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 1.48 [0.33;6.70] C
excluded (control group)
12/703   2/173 14 703
ref
S5911
R14912
Artama (Valproate) (Controls unexposed, disease free), 2013 Small for gestational age (weight) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: Yes 0.72 [0.41;1.29]
excluded (control group)
12/703   14,079/719,509 14,091 703
ref
S5919
R15008
Artama (Valproate) (Controls unexposed, sick), 2013 Small for gestational age (weight) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: Yes 0.68 [0.35;1.33] 12/703   42/1,793 54 703
ref
S6353
R17323
Veiby (Valproate) (Controls exposed to Lamotrigine, sick) b, 2013 Small for gestational age (SGA) birth weight during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 1.03 [0.19;5.55] C
excluded (control group)
2/40   5/103 7 40
ref
S5506
R17327
Veiby (Valproate) (Controls unexposed, disease free) b, 2013 Small for gestational age (SGA) birth weight during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: Yes 0.90 [0.20;3.70]
excluded (control group)
2/40   8,017/106,899 8,019 40
ref
S6350
R17331
Veiby (Valproate) (Controls unexposed, sick) b, 2013 Small for gestational age (SGA) birth weight during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 0.60 [0.14;2.62] C 2/40   31/386 33 40
ref
S6416
R17611
Pennell (Valproate), 2012 Small for gestational age (SGA) (at birth) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: Yes 4.08 [1.11;14.96] 9/62   4/98 13 62
ref
S6623
R18198
Burja (Valproate) (Controls unexposed, disease free), 2006 Small for date (NOS) during pregnancy (anytime or not specified) retrospective cohort (registry) unexposed, disease free excluded Adjustment: No 8.17 [0.49;135.15] C
excluded (control group)
1/2   23/211 24 2
ref
S6619
R18178
Burja (Valproate) (Controls unexposed, sick), 2006 Small for date (NOS) during pregnancy (anytime or not specified) retrospective cohort (registry) unexposed, sick Adjustment: No 31.00 [1.02;941.06] C 1/2   1/32 2 2
ref
S8221
R25733
Endo (Valproate) (Controls unexposed, disease free), 2004 Intrauterine growth retardation (NOS) at least 1st trimester retrospective cohort unexposed, disease free excluded Adjustment: No 2.00 [0.11;37.93] C
excluded (control group)
0/5   34/656 34 5
ref
S8311
R26290
Endo (Valproate) (Controls unexposed, sick), 2004 Intrauterine growth retardation (NOS) throughout pregnancy retrospective cohort unexposed, sick Adjustment: No 0.11 [0.00;14.76] C 0/5   0/1 0 5
ref
Total 10 studies 1.34 [0.97;1.85] 209,368 3,888
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 Dreier (Valproate), 2021Dreier, 2021 1 1.09[0.92; 1.30]-1,94324%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Aydin (Valproate) (Controls unexposed, sick), 2020Aydin, 2020 2 2.05[0.04; 110.56]0111%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Coste (Valproate) (Controls unexposed, NOS), 2020Coste, 2020 3 1.63[1.37; 1.94]167,52599124%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Cohen (Valproate) (Controls unexposed NOS), 2019Cohen, 2019 4 0.97[0.49; 1.95]41,644-12%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Putignano (Valproate), 2019Putignano, 2019 5 2.27[1.35; 3.79]9713116%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Artama (Valproate) (Controls unexposed, sick), 2013Artama, 2013 6 0.68[0.35; 1.33]5470312%ROB confusion: moderateROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Veiby (Valproate) (Controls unexposed, sick) b, 2013Veiby, 2013 7 0.60[0.14; 2.62]33404%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Pennell (Valproate), 2012Pennell, 2012 8 4.08[1.11; 14.96]13625%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Burja (Valproate) (Controls unexposed, sick), 2006Burja, 2006 9 31.00[1.02; 941.06]221%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Endo (Valproate) (Controls unexposed, sick), 2004Endo, 2004 10 0.11[0.00; 14.76]050%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (10 studies) I2 = 67% 1.34[0.97; 1.85]209,3683,8880.0100.01.0ROB: 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, NOS; 4: Valproate) (Controls unexposed NOS; 5: Valproate; 6: Valproate) (Controls unexposed, sick; 7: Valproate) (Controls unexposed, sick) ; 8: Valproate; 9: Valproate) (Controls unexposed, sick; 10: Valproate) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.34[0.97; 1.85]209,3683,88867%NADreier (Valproate), 2021 Aydin (Valproate) (Controls unexposed, sick), 2020 Coste (Valproate) (Controls unexposed, NOS), 2020 Cohen (Valproate) (Controls unexposed NOS), 2019 Putignano (Valproate), 2019 Artama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Pennell (Valproate), 2012 Burja (Valproate) (Controls unexposed, sick), 2006 Endo (Valproate) (Controls unexposed, sick), 2004 10 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.62[1.16; 2.27]209,2661,12246%NACoste (Valproate) (Controls unexposed, NOS), 2020 Cohen (Valproate) (Controls unexposed NOS), 2019 Putignano (Valproate), 2019 3 unexposed, sickunexposed, sick 0.95[0.58; 1.54]892,70429%NADreier (Valproate), 2021 Aydin (Valproate) (Controls unexposed, sick), 2020 Artama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Burja (Valproate) (Controls unexposed, sick), 2006 Endo (Valproate) (Controls unexposed, sick), 2004 6 exposed to other treatment, sickexposed to other treatment, sick 4.08[1.11; 14.98]1362 -NAPennell (Valproate), 2012 1 Tags Adjustment   - No  - No 1.73[1.13; 2.65]167,6571,18031%NAAydin (Valproate) (Controls unexposed, sick), 2020 Coste (Valproate) (Controls unexposed, NOS), 2020 Putignano (Valproate), 2019 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Burja (Valproate) (Controls unexposed, sick), 2006 Endo (Valproate) (Controls unexposed, sick), 2004 6   - Yes  - Yes 1.07[0.71; 1.62]41,7112,70850%NADreier (Valproate), 2021 Cohen (Valproate) (Controls unexposed NOS), 2019 Artama (Valproate) (Controls unexposed, sick), 2013 Pennell (Valproate), 2012 4 MatchedMatched 2.27[1.35; 3.79]97131 -NAPutignano (Valproate), 2019 1 All studiesAll studies 1.34[0.97; 1.85]209,3683,88867%NADreier (Valproate), 2021 Aydin (Valproate) (Controls unexposed, sick), 2020 Coste (Valproate) (Controls unexposed, NOS), 2020 Cohen (Valproate) (Controls unexposed NOS), 2019 Putignano (Valproate), 2019 Artama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Pennell (Valproate), 2012 Burja (Valproate) (Controls unexposed, sick), 2006 Endo (Valproate) (Controls unexposed, sick), 2004 100.0100.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-5.96.22.9930.000Dreier (Valproate), 2021Aydin (Valproate) (Controls unexposed, sick), 2020Coste (Valproate) (Controls unexposed, NOS), 2020Cohen (Valproate) (Controls unexposed NOS), 2019Putignano (Valproate), 2019Artama (Valproate) (Controls unexposed, sick), 2013Veiby (Valproate) (Controls unexposed, sick) b, 2013Pennell (Valproate), 2012Burja (Valproate) (Controls unexposed, sick), 2006Endo (Valproate) (Controls unexposed, sick), 2004

Asymetry test p-value = 0.8803 (by Egger's regression)

slope=0.2749 (0.1471); intercept=0.1234 (0.7934); t=0.1555; p=0.8803

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 8221, 6623, 5931, 5911, 6353, 5506, 8143, 8087

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.36[0.93; 2.01]231,4341,87254%NACoste (Valproate) (Controls unexposed, NOS), 2020 Cohen (Valproate) (Controls unexposed NOS), 2019 Putignano (Valproate), 2019 Artama (Valproate) (Controls unexposed, disease free), 2013 Veiby (Valproate) (Controls unexposed, disease free) b, 2013 Burja (Valproate) (Controls unexposed, disease free), 2006 Endo (Valproate) (Controls unexposed, disease free), 2004 7 unexposed, sick controlsunexposed, sick controls 0.95[0.58; 1.54]892,70429%NADreier (Valproate), 2021 Aydin (Valproate) (Controls unexposed, sick), 2020 Artama (Valproate) (Controls unexposed, sick), 2013 Veiby (Valproate) (Controls unexposed, sick) b, 2013 Burja (Valproate) (Controls unexposed, sick), 2006 Endo (Valproate) (Controls unexposed, sick), 2004 6 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.79[0.95; 3.39]348160%NAAydin (Valproate) (Controls exposed to Lamotrigine, sick), 2020 Cohen (Valproate) (Controls exposed to Lamotrigine, sick), 2019 Artama (Valproate) (Controls exposed to Lamotrigine, sick), 2013 Veiby (Valproate) (Controls exposed to Lamotrigine, sick) b, 2013 Pennell (Valproate), 2012 50.510.01.0