Reviewer's report
Title:The prevalence and nature of the use of preconception services by women
with chronic health conditions: a critical review
Version:2Date:31 October 2014
Reviewer: Cheryl Robbins
Reviewer's report:
The topic of the paper is of interest and I believe that the paper has potential for
publication but substantive revisions are needed. In its current form, I found the
paper to be unfocused, the writing could be more concise and precise, and
attention to details was lacking (as evidenced by multiple errors and noted in
comments below).
Major Compulsory Revisions
1. Abstract: The abstract needs to be substantively revised. The first sentence is
not self-evident. More details about inclusion criteria are needed. The results are
vague and uninformative. It is unclear whose “knowledge of the value and impact
of preconception care and availability of services” was assessed. The conclusion
is not supported by the results.
2. If the authors’ claim is true (“this is the first systematic review of contemporary
research outlining the use of preconception services and practices by women
with chronic health conditions”), why was this review limited to the past ten
years? I recommend expanding the search to include at least the last 20 years
and 30 years would be even better.
3. I am not sure that reference #2 supports the statement (line 54) as the link is
broken.
4. Folic acid supplementation has also been clearly identified as an important
preconception health behavior and should be added to the section on “Impact of
preconception health status on outcomes for women and neonates.”
5. Citation is needed for the sentence that ends on line 70.
6. What evidence is there validating the dimensions included in the quality
assessment tool? Even its face validity is lacking in my opinion (e.g., duration of
chronic health condition and pre-conception care services examined). I would
suggest using a validated, structured tool to assess the quality of bias in
individual studies. For example, the Community Guide tool offers flexibility in
evaluating papers with different study designs
(http://www.thecommunityguide.org/library/ajpm355_d.pdf).
Reference: Zaza S, Wright-De Agu¨ero LK, Briss PA, Truman BI, Hopkins DP,
Hennessy MH, et al. Data Collection Instrument and Procedure for Systematic
Reviews in the Guide to Community Preventive Services. Am J Prev Med
2000;18(1S):44-74
7. It is unclear why a study that did not address any of the preconception care
services included in the quality assessment would have been included in a
review of studies that examined preconception care services (reference #43, line
169). Moreover, if that study focused on glucose control or family planning
counseling as suggested in lines 188-191, it seems like it would have received at
least one point for dimension #L and possibly one point for M. These
inconsistencies further call into question the validity of the quality assessment
criteria.
8. More details about the search strategy are needed to determine soundness of
methods used or possibility of replication. If only “preconception care/prenatal
care” were used as descriptors of preconception health care, important studies
that examined components of preconception care services (such as family
planning and preventive health care) may have been missed.
9. It appears that two additional papers were excluded but are unaccounted for in
Figure 1. The figure and corresponding text needs to be fixed.
10. The section on critical appraisal and analysis seems unduly lengthy and
contains explanations that are unnecessary.
11. Please define “comprehensive preconception clinical care services” (line 136)
12. Results should detail source of data from studies and how preconception
care services were measured.
13. Two of the categories/sections (“Knowledge of the value and impact of
preconception care and availability of preconception services” and “Attitudes,
approaches and experiences of preconception care and preconception services”)
are amorphous and therefore the organization of their respective results is not
cohesive.
14. While I found the discussion section to be the best organized and easy to
follow, the proposed research priorities (that structured the discussion section)
come out-of-the-blue and are not supported by the results.
15. Tables should stand alone. Table 2 is uninterpretable without referring to
Table 1.
16. Table 3 should be revised to be more informative – add a column to
summarize prevalence estimates of conditions.
Minor essential revisions
17. Line 73: typo. I believe the authors intended to say “type 1 or type 2.”
18. Line 138: “These three broad categories”: I believe the authors are referring
to the three dimensions stated on line 119 but that is not immediately obvious to
the reader since there is so much in between those two lines.
19. Table 1 title is inappropriate. Please rename. Text describing the dimensions
does not match what is in the table (e.g. sample size for quantitative studies).
20. The sentence referencing Table 2 on Line 143 is a result and should be
moved to that section.
21. The sentence referencing Table 3 on Lines 151-152 is a result and should be
moved to that section.
22. Please add reference numbers to Tables 2 and 3 to aid the reader in easily
locating the papers in the reference list.
Discretionary Revisions
23. Suggested citation to add to line 61 (with reference 15): Bombard JM, Dietz
PM, Galavotti C, et al.: Chronic Diseases and Related Risk Factors among
Low-Income Mothers. Maternal and child health journal. 2012;16:60-71.
24. Authors use “pregestational” to refer to type 1 or 2 diabetes and
“preconception hypertension” – I think it would be more straightforward just to
use “diabetes” and “hypertension” when not referring to gestational diabetes or
gestational hypertension.
25. Suggest replacing reference 28 with one that also addresses other
autoimmune disease
26. Suggest adding epilepsy to lines 79-80 (suggested citation: Shannon, G. D.,
et al. (2013). "Preconception Healthcare Delivery at a Population Level:
Construction of Public Health models of Preconception Care." Maternal and Child
Health Journal.)
27. Suggested citation to add to line 85: Temel S, et al. (2014). "Evidence-Based
Preconceptional Lifestyle Interventions." Epidemiol Rev. 36(1): 19-30.
28. Suggest specifying which researches collected and extracted data (i.e., first
and last initials only).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests