Are women using hormonal contraceptives the risk-takers?
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COMMENTARY
Are women using hormonal contraceptives the risk‑takers? Henning Tiemeier1 Received: 4 September 2020 / Accepted: 8 September 2020 / Published online: 23 September 2020 © The Author(s) 2020
More than 20 years ago, I attended an epidemiology course with group assignments on study design. Our group was tasked to design a study of the unintended effects of the third-generation pill. I was the proud presenter. When I returned to my seat I understood my group had failed. Confounding by indication would invalidate our observational design. “It is a difficult challenge”, the instructor consoled us. The task Hemmingsen et al. have taken on in the present study is much more challenging and is complicated not only by possible confounding by indication [1]. The authors try and conduct a valid study of the offspring neurodevelopmental consequences related to the use of hormonal contraception in the period prior to conception. To this aim they define a nation-wide population-based cohort of more than 1 million children born in Denmark between 1998 and 2014. This cohort is constructed using data from different registries such as the Danish National Prescription Registry to assess contraceptive use, the Danish Patient Register to establish incident ADHD in children, and the Danish National Birth and other registers to obtain demographic and important confounder information. Mothers who recently used contraceptives before or around conception, are about 30% more likely to have a child that will develop ADHD. This pattern of higher offspring ADHD risk was consistently found for all forms of contraception, oral and non-oral, combined and non-combined hormonal contraceptives. The association for progestin-only contraceptives was somewhat stronger; although this effect size difference was clearly not significant. The importance of the present paper is that it raises the possibility that hormonal contraceptive use of the mother might have unintended side effects on the development of the offspring, that is intergenerational effects. Although * Henning Tiemeier [email protected] 1
Sumner and Esther Feldberg Chair in Maternal and Child Health, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave., 6th floor, Boston, MA 02115, USA
many unwanted side effects are established, these typically desist relatively soon after the contraceptive use is stopped. Contraceptives are very safe drugs [2]; many researchers and clinicians will find the possibility of intergenerational effects not very plausible. Luckily, women are not prescribed a certain anti-contraceptive randomly. The choice should be made by the women on the basis of safety (possible unintended effects), effectiveness, and acceptability. However, any of these set of indication criteria may come with certain characteristics of the women and on a group level, that may make a certain unintended outcome more likely. The thromboembolic, cardiovascular and mood problems of the different hormonal contraceptives wer
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