Study Design and Limitations

The retrospective design prevents causal interpretation; preconception TSH may be a surrogate marker for unmeasured factors that independently promote LGA or SGA. The study's inability to measure free T4 or TPO-Ab precluded analysis of thyroid autoimmunity and the differential effects of T4 on fetal growth. The study population of exclusively rural Chinese women limits extrapolation to other ethnic groups or healthcare settings. The study used document analysis across eight South Asian countries and stakeholder interviews in six countries. The cross-sectional design prevents the study from establishing causal direction between exposure and product use. Thirty stakeholders were interviewed between 1 March 2025 and 30 June 2025. The cross-sectional design prevents causal inference. Because the study was cross-sectional, it could not establish causal or temporal relationships between structural factors and service provision. The 2023 WHO Essential Medicines List was used as the benchmark for extracting data on 67 anticancer medicines. The study lacked transition-stage information for transgender men and men with other gender identities. Important limitations included single-centre re…