Atenolol (versus unexposed) updated on 12-17-2024

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.
S17135
R71869		 Delteil, 2024 Small for gestational age (weight) at least 1st trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: Only chronic indication (hypertension or cardiac) 3.14 [1.70;5.54] 16/58   13,794/135,159 13,810 58
ref
S17238
R72140		 Albertini, 2023 Intrauterine growth restriction (birth weight <10th percentile based on the World Health Organization growth curves for female and male infants) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 6.81 [0.32;144.64] C 5/16   0/7 5 16
ref
S13511
R52196		 Fitton (Controls unexposed, disease free), 2020 Small for gestational age (birth weight below the 10th percentile) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, disease free excluded Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 3.83 [2.03;7.21]
excluded (control group) 		24/95   24,121/250,693 24,145 95
ref
S14419
R57245		 Fitton (Controls unexposed, sick), 2020 Small for gestational age (birth weight below the 10th percentile) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 2.21 [1.38;3.52] C 24/95   1,059/7,971 1,083 95
ref
S13911
R54418		 Duan, 2018 Small for gestational age (birth weight <10th percentile for the corresponding gestational week) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 2.40 [1.70;3.30] 112/638   32,488/374,391 32,600 638
ref
S14074
R55408		 Tanaka, 2016 Fetal growth restriction (considered equivalent to light for gestational age, birth weight <10th percentile for gestational age) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 16.17 [2.08;125.55] C 2/6   3/100 5 6
ref
S14363
R56873		 Orbach, 2013 Small for gestational age 3rd trimester retrospective cohort (claims database) unexposed, disease free Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 4.80 [2.07;11.10] 6/107   1,704/97,820 1,710 107
ref
S14358
R56850		 Bayliss, 2002 Small for gestational age (birth weight for gestation on or below the 10th percentile using Gairdner– Pearson growth charts) throughout pregnancy retrospective cohort unexposed, sick Adjustment: Yes Indications Antihypertensive: Only chronic hypertension indication 2.81 [1.27;6.24] 26/40   49/171 75 40
ref
S14298
R56329		 Lydakis, 1999 Small for gestational age (<10th percentile) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 3.60 [1.84;7.06] C 38/78   19/91 57 78
ref
Total 8 studies 2.78 [2.23;3.46] 49,345 1,038
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 Delteil, 2024Delteil, 2024 3.14[1.70; 5.54]13,8105813%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Albertini, 2023Albertini, 2023 6.81[0.32; 144.64]5161%ROB confusion: criticalROB selection: unclearROB classification: unclearROB missing: unclearROB mesure: unclearROB reporting: moderate Fitton (Controls unexposed, sick), 2020Fitton, 2020 1 2.21[1.38; 3.52]1,0839521%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Duan, 2018Duan, 2018 2.40[1.70; 3.30]32,60063839%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Tanaka, 2016Tanaka, 2016 16.17[2.08; 125.55]561%ROB confusion: seriousROB selection: criticalROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Orbach, 2013Orbach, 2013 4.80[2.07; 11.10]1,7101077%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Bayliss, 2002Bayliss, 2002 2.81[1.27; 6.24]75407%ROB confusion: seriousROB selection: lowROB classification: lowROB missing: unclearROB mesure: moderateROB reporting: moderate Lydakis, 1999Lydakis, 1999 3.60[1.84; 7.06]577810%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Total (8 studies) I2 = 3% 2.78[2.23; 3.46]49,3451,0380.950.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.78[2.23; 3.46]49,3451,0383%NADelteil, 2024 Albertini, 2023 Fitton (Controls unexposed, sick), 2020 Duan, 2018 Tanaka, 2016 Orbach, 2013 Bayliss, 2002 Lydakis, 1999 8 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.85[2.03; 3.99]48,12080321%NADelteil, 2024 Duan, 2018 Orbach, 2013 3 unexposed, sickunexposed, sick 2.91[1.95; 4.33]1,22523514%NAAlbertini, 2023 Fitton (Controls unexposed, sick), 2020 Tanaka, 2016 Bayliss, 2002 Lydakis, 1999 5 Tags Adjustment   - No  - No 3.22[1.78; 5.83]1,15019536%NAAlbertini, 2023 Fitton (Controls unexposed, sick), 2020 Tanaka, 2016 Lydakis, 1999 4   - Yes  - Yes 2.74[2.12; 3.55]48,1958430%NADelteil, 2024 Duan, 2018 Orbach, 2013 Bayliss, 2002 4 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 2.55[1.86; 3.51]35,39384025%NAFitton (Controls unexposed, sick), 2020 Duan, 2018 Orbach, 2013 3   - Only cardiac indications other than ...  - Only cardiac indications other than hypertension (long QT syndrome, structural heart disease, ...) 12.36[2.25; 67.82]10220%NAAlbertini, 2023 Tanaka, 2016 2   - Only chronic hypertension indication  - Only chronic hypertension indication 3.25[1.94; 5.43]1321180%NABayliss, 2002 Lydakis, 1999 2   - Only chronic indication (hypertensi ...  - Only chronic indication (hypertension or cardiac) 3.14[1.74; 5.67]13,81058 -NADelteil, 2024 1 All studiesAll studies 2.78[2.23; 3.46]49,3451,0383%NADelteil, 2024 Albertini, 2023 Fitton (Controls unexposed, sick), 2020 Duan, 2018 Tanaka, 2016 Orbach, 2013 Bayliss, 2002 Lydakis, 1999 80.550.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.74.71.8710.000Delteil, 2024Albertini, 2023Fitton (Controls unexposed, sick), 2020Duan, 2018Tanaka, 2016Orbach, 2013Bayliss, 2002Lydakis, 1999

Asymetry test p-value = 0.0123 (by Egger's regression)

slope=0.5872 (0.1386); intercept=1.5965 (0.4516); t=3.5355; p=0.0123

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13511

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.97[2.24; 3.93]72,26589813%NADelteil, 2024 Fitton (Controls unexposed, disease free), 2020 Duan, 2018 Orbach, 2013 4 unexposed, sick controlsunexposed, sick controls 2.91[1.95; 4.33]1,22523514%NAAlbertini, 2023 Fitton (Controls unexposed, sick), 2020 Tanaka, 2016 Bayliss, 2002 Lydakis, 1999 50.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Bellos (Small for gestational age (Randomized ...Bellos (Small for gestational age (Randomized controlled trial and Cohort studies)) 4.95[2.72; 8.98]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos (Small-for-gestational age (Randomized ...Bellos (Small-for-gestational age (Randomized controlled trial only)) Out of scale26.00[2.61; 259.29]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 metaPregmetaPreg 2.78[2.23; 3.46]3%1,038----Delteil, 2024 Albertini, 2023 Fitton (Controls unexposed, sick), 2020 Duan, 2018 Tanaka, 2016 Orbach, 2013 Bayliss, 2002 Lydakis, 1999 80.510.01.0