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\title{Methodological concern. (Mini-commentary on BJOG-20-0063.R1)}



\author[1]{Steven Lane}%
\affil[1]{University of Liverpool}%


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  \date{March 15, 2025}


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Mini-commentary on BJOG-20-0063.R1: Association of maternal attention
deficit hyperactivity disorder and preterm birth: a cohort study

\textbf{Methodological concern}

Steven Lane

University of Liverpool

Institute of Translational Medicine

Liverpool, UK

Email: Slane@liverpool.ac.uk

A note of caution is advised on the definition of a woman considered to
have ADHD at some time-point before, during or post pregnancy. In the
reported study women were considered to have had an episode of ADHD if
they were dispensed a prescription for an ADHD medication (Hesselman et
al. BJOG 2020 xxxx). This will not be as accurate as a clinical
diagnosis of the condition. Dispensing medication depends on the women
presenting the prescription at a pharmacy, which is not always the case
when mental health issues are prevalent. There is, therefore, a strong
possibility that the estimates of women with and without ADHD are
inaccurate and that both groups contain a mixture of women both with and
without ADHD. As it is likely that some prescriptions were not presented
then, statistically, it is likely that the number of women with ADHD is
underestimated. It should also be noted that, in this cohort of women,
medication is only prescribed if other supportive measures have failed,
again suggesting an under estimation of true ADHD cases, and that the
prescribed medications could be prescribed for other mental health
conditions, this time possibly over estimating ADHD cases. In summary,
this is an interesting study and the authors have highlighted the issues
relating to the accuracy of the definition of an ADHD case in the
discussion section, readers should consider these limitations when
interpreting the results of the study.

\textbf{No disclosures:} A completed disclosure of interest form is
available to view online as supporting information.

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