Phenytoin (All indications) 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.
S19381
R82484
Straub (Controls exposed to LTG) (Phenytoin) (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 2.96 [2.26;3.89] C
excluded (control group)
121/1,390   102/3,273 223 1,390
ref
S19370
R82491
Straub (Controls unexposed, sick) (Phenytoin) (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 0.97 [0.78;1.21] 121/1,390   366/8,887 487 1,390
ref
S17390
R72907
Madley-Dowd_SE (Phenytoin) (Controls exposed to LTG) (Mixed indications), 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: Yes 1.32 [0.88;1.97]
excluded (control group)
26/194   243/5,035 269 194
ref
S17391
R72913
Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 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 (general population or NOS) Adjustment: Yes 1.13 [0.77;1.67] 26/194   147,608/2,651,210 147,634 194
ref
S17392
R72919
Madley-Dowd_SE (Phenytoin) (Controls unexposed, sibling) (Mixed indications), 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 sibling excluded Adjustment: Yes 2.98 [0.81;11.01]
excluded (control group)
-/-   -/- - -
ref
S17283
R72369
Madley-Dowd_UK (Phenytoin) (Controls exposed to LTG) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median follow up 10.75 (7.82-13.62) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: Yes 1.31 [0.17;9.91]
excluded (control group)
-/46   14/939 - 46
ref
S17268
R72370
Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median follow up 10.75 (7.82-13.62) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes 2.15 [0.30;15.39] -/46   4,794/514,066 - 46
ref
S17276
R72371
Madley-Dowd_UK (Phenytoin) (Controls unexposed, sibling) (Mixed indications), 2024 Attention Deficit Hyperactivity Disorder - ICD10 codes and/or ADHD medication prescription - Median follow up 10.75 (7.82-13.62) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) sibling excluded Adjustment: Yes 38.49 [9.14;162.11]
excluded (control group)
-/-   -/- - -
ref
S9260
R48803
Cohen (Phenytoin), 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 0.42 [0.04;4.11] C 1/17   4/31 5 17
ref
Total 4 studies 1.01 [0.83;1.22] 148,126 1,647
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) (Phenytoin) (Epilepsy), 2026Straub, 2026 1 0.97[0.78; 1.21]4871,39074%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: criticalROB reporting: moderate Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_SE, 2024 2 1.13[0.77; 1.67]147,63419424%ROB confusion: seriousROB selection: lowROB classification: lowROB missing: lowROB mesure: criticalROB reporting: moderate Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_UK, 2024 3 2.15[0.30; 15.39]-461%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Cohen (Phenytoin), 2013Cohen, 2013 4 0.42[0.04; 4.11]5171%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: criticalROB mesure: lowROB reporting: low Total (4 studies) I2 = 0% 1.01[0.83; 1.22]148,1261,6470.25.01.0ROB: A: confounding, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick) (Phenytoin) (Epilepsy; 2: Phenytoin) (Controls unexposed, general pop) (Mixed indications; 3: Phenytoin) (Controls unexposed, general pop) (Mixed indications; 4: Phenytoin;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.01[0.83; 1.22]148,1261,6470%NAStraub (Controls unexposed, sick) (Phenytoin) (Epilepsy), 2026 Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Cohen (Phenytoin), 2013 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.16[0.79; 1.69]147,6342400%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 2 unexposed, sickunexposed, sick 0.97[0.78; 1.21]4871,390 -NAStraub (Controls unexposed, sick) (Phenytoin) (Epilepsy), 2026 1 exposed to other treatment, sickexposed to other treatment, sick 0.42[0.04; 4.11]517 -NACohen (Phenytoin), 2013 1 Tags Adjustment   - No  - No 0.42[0.04; 4.11]517 -NACohen (Phenytoin), 2013 1   - Yes  - Yes 1.01[0.84; 1.23]148,1211,6300%NAStraub (Controls unexposed, sick) (Phenytoin) (Epilepsy), 2026 Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 3 All studiesAll studies 1.01[0.83; 1.22]148,1261,6470%NAStraub (Controls unexposed, sick) (Phenytoin) (Epilepsy), 2026 Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Cohen (Phenytoin), 2013 40.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.72.71.3940.000Straub (Controls unexposed, sick) (Phenytoin) (Epilepsy), 2026Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Cohen (Phenytoin), 2013

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 17390, 17392, 17283, 17276, 19381

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.16[0.79; 1.69]152,4192400%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 2 unexposed, sick controlsunexposed, sick controls 0.97[0.78; 1.21]4871,390 -NAStraub (Controls unexposed, sick) (Phenytoin) (Epilepsy), 2026 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.70[0.84; 3.45]5021,64777%NAStraub (Controls exposed to LTG) (Phenytoin) (Epilepsy), 2026 Madley-Dowd_SE (Phenytoin) (Controls exposed to LTG) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls exposed to LTG) (Mixed indications), 2024 Cohen (Phenytoin), 2013 4 siblingssiblings Out of scale10.51[0.86; 128.98]--85%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, sibling) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, sibling) (Mixed indications), 2024 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Veroniki b (NMA) (Attention deficit hyperacti ...Veroniki b (NMA) (Attention deficit hyperactivity disorder) 0.63[0.07; 4.07]NA-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT-9 metaPregmetaPreg 1.01[0.83; 1.22]0%1,647----Straub (Controls unexposed, sick) (Phenytoin) (Epilepsy), 2026 Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Cohen (Phenytoin), 2013 40.510.01.0