Phenytoin (All indications)

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.
S9192
R31821
Aydin (Phenytoin) (Controls exposed to Lamotrigine, sick), 2020 Small for gestational age (birth weight) throughout pregnancy retrospective cohort exposed to other treatment, sick excluded Adjustment: No 13.00 [0.10;1680.94] C
excluded (control group)
0/1   0/7 0 1
ref
S9193
R31831
Aydin (Phenytoin) (Controls unexposed, sick), 2020 Small for gestational age (birth weight) throughout pregnancy retrospective cohort unexposed, sick Adjustment: No 43.00 [0.35;5328.22] C 0/1   0/22 0 1
ref
S9272
R32151
Bank (Phenytoin) (Mixed indications), 2017 Small for Gestational Age birthweight (<10th percentile) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 1.86 [0.07;46.97] C 0/3   3/36 3 3
ref
S9275
R32161
Kilic (Phenytoin) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2014 Small for gestational age (birth weight <10% percentile for the gestational birth week) during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 2.56 [0.28;23.17] C
excluded (control group)
1/5   78/876 79 5
ref
S9276
R32164
Kilic (Phenytoin) (Controls unexposed NOS) (Mixed indications), 2014 Small for gestational age (birth weight <10% percentile for the gestational birth week) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: No 2.34 [0.26;20.91] C
excluded (control group)
1/5   65,118/673,844 65,119 5
ref
S9277
R32167
Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014 Small for gestational age (birth weight <10% percentile for the gestational birth week) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No Controls: epilepsy indication 1.97 [0.22;17.66] C 1/5   594/5,275 595 5
ref
S9187
R31779
Artama (Phenytoin) (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 1.34 [0.06;28.66] C
excluded (control group)
0/26   2/173 2 26
ref
S9188
R31791
Artama (Phenytoin) (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: No 0.98 [0.06;16.14] C
excluded (control group)
0/26   14,079/719,509 14,079 26
ref
S9190
R31815
Artama (Phenytoin) (Controls unexposed, sick), 2013 Small for gestational age (weight) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No 0.81 [0.05;13.49] C 0/26   42/1,793 42 26
ref
S9216
R31975
Pennell (Phenytoin), 2012 Small for gestational age (SGA) (at birth) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: Yes 0.56 [0.09;3.46] 2/55   4/98 6 55
ref
S9223
R31998
Wide (Phenytoin), 2000 Small for gestationnal age throughout pregnancy prospective cohort unexposed (general population or NOS) Adjustment: No Matched 0.86 [0.02;45.54] C 0/22   0/19 0 22
ref
Total 6 studies 1.20 [0.40;3.58] 646 112
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 Aydin (Phenytoin) (Controls unexposed, sick), 2020Aydin, 2020 1 43.00[0.35; 5328.22]015%ROB confusion: criticalROB selection: criticalROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Bank (Phenytoin) (Mixed indications), 2017Bank, 2017 2 1.86[0.07; 46.97]3311%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014Kilic, 2014 3 1.97[0.22; 17.66]595525%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Artama (Phenytoin) (Controls unexposed, sick), 2013Artama, 2013 4 0.81[0.05; 13.49]422615%ROB confusion: moderateROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Pennell (Phenytoin), 2012Pennell, 2012 5 0.56[0.09; 3.46]65536%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Wide (Phenytoin), 2000Wide, 2000 6 0.86[0.02; 45.54]0228%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Total (6 studies) I2 = 0% 1.20[0.40; 3.58]6461120.2100.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Phenytoin) (Controls unexposed, sick; 2: Phenytoin) (Mixed indications; 3: Phenytoin) (Controls unexposed, sick) (Mixed indications; 4: Phenytoin) (Controls unexposed, sick; 5: Phenytoin; 6: Phenytoin;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.20[0.40; 3.58]6461120%NAAydin (Phenytoin) (Controls unexposed, sick), 2020 Bank (Phenytoin) (Mixed indications), 2017 Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Phenytoin) (Controls unexposed, sick), 2013 Pennell (Phenytoin), 2012 Wide (Phenytoin), 2000 6 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 0.86[0.02; 45.54]-22 -NAWide (Phenytoin), 2000 1 unexposed, sickunexposed, sick 2.08[0.41; 10.59]637320%NAAydin (Phenytoin) (Controls unexposed, sick), 2020 Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Phenytoin) (Controls unexposed, sick), 2013 3 exposed to other treatment, sickexposed to other treatment, sick 0.75[0.15; 3.67]9580%NABank (Phenytoin) (Mixed indications), 2017 Pennell (Phenytoin), 2012 2 Tags Adjustment   - No  - No 1.84[0.47; 7.19]640570%NAAydin (Phenytoin) (Controls unexposed, sick), 2020 Bank (Phenytoin) (Mixed indications), 2017 Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Phenytoin) (Controls unexposed, sick), 2013 Wide (Phenytoin), 2000 5   - Yes  - Yes 0.56[0.09; 3.47]655 -NAPennell (Phenytoin), 2012 1 Controls   - epilepsy indication  - epilepsy indication 1.97[0.22; 17.66]5955 -NAKilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014 1 MatchedMatched 0.86[0.02; 45.54]-22 -NAWide (Phenytoin), 2000 1 All studiesAll studies 1.20[0.40; 3.58]6461120%NAAydin (Phenytoin) (Controls unexposed, sick), 2020 Bank (Phenytoin) (Mixed indications), 2017 Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Phenytoin) (Controls unexposed, sick), 2013 Pennell (Phenytoin), 2012 Wide (Phenytoin), 2000 60.2100.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-5.86.02.9510.000Aydin (Phenytoin) (Controls unexposed, sick), 2020Bank (Phenytoin) (Mixed indications), 2017Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014Artama (Phenytoin) (Controls unexposed, sick), 2013Pennell (Phenytoin), 2012Wide (Phenytoin), 2000

Asymetry test p-value = 0.1470 (by Egger's regression)

slope=-1.8289 (1.1787); intercept=1.5491 (0.8628); t=1.7955; p=0.1470

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9187, 9188, 9275, 9276, 9192

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.51[0.31; 7.36]79,198530%NAKilic (Phenytoin) (Controls unexposed NOS) (Mixed indications), 2014 Artama (Phenytoin) (Controls unexposed, disease free), 2013 Wide (Phenytoin), 2000 3 unexposed, sick controlsunexposed, sick controls 2.08[0.41; 10.59]637320%NAAydin (Phenytoin) (Controls unexposed, sick), 2020 Kilic (Phenytoin) (Controls unexposed, sick) (Mixed indications), 2014 Artama (Phenytoin) (Controls unexposed, sick), 2013 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.34[0.42; 4.24]90900%NAAydin (Phenytoin) (Controls exposed to Lamotrigine, sick), 2020 Bank (Phenytoin) (Mixed indications), 2017 Kilic (Phenytoin) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2014 Artama (Phenytoin) (Controls exposed to Lamotrigine, sick), 2013 Pennell (Phenytoin), 2012 50.510.01.0