Reviewer's report
Title:Preconception care for women with diabetes: A review of current guideline
recommendations
Version: 1Date:4 September 2009
Reviewer: Denise Charron-Prochownik
Reviewer's report:
Overall, this is a well written review of PC guidelines and summary of
recommendations for women with T2D. I'm most familar with ADA guidelines and
can speak about them. I found that some of the information in the text and tables
were missing. In addition, there are some issues that need to be addressed.
Major Compulsory Revisions:
1) Methods:
-Please include the credentials and expertise of the appraisers.
-Describe items and scoring scheme of AGREE.
-Describe how the categories ("headings") were determined.
-The heading "blood sugar control" mentioned in Methods does not appear in
Results. Results has "Insulin Use". Please be consistent.
2)Results:
-Why was ACOG not selected as guidelines?
-In the third line under Results, the word "...chapter..." should be replaced with
"secton".
-ADA 2009 only highlights main points and updates from ADA 2004 guidelines,
and refers the reader to ADA 2004 for "further discussion of PC" and more
comprehensive information. (This sentence should be added as the third
sentence in the first paragraph under Results. It should also be added as a
footnote with a * in Table 3.).
-How was it determined that "all guidelines were rated as being of high quality"?
-Under "Counselling", it should be mentioned that ADA 2009 gave a new
recommendation for Preconception Counseling (PC) to "start at puberty" in
addition to routinely incorporated into diabetic care.
3) Discussion:
- In the middle of the first paragraph, it should be mentioned that "ADA 2009 has
less checks in Table 3 because it's part of a general Practice Guideline on
Standards of Medical Care, and was not meant to be comprehensive for PC like
the other guidelines in the table.
4) Table 3:
- Under column "ADA 2009":
place a check in "Evaluation and treatment of DM complication" (see ADA 2009
p. S40), "Hypertention" (p. S40); in "Counseling" add "and starting at puberty".
- Under column "ADA 2004":
place a check in "Evaluation and treatment of DM complication" (see ADA 2004
p. S78), "Review all medication" (p. S77), "Stop B-blocker" (p. S78), "Educate on
hypoglycemia.." (p. S77 & S78), "Dietary advice" (p. S77); in "Counseling" add
"Counseling for all women with diabetes who have child-bearing potential" (p.
S76 & S77).
5) Table 4:
- the first bullet should read: "Starting at puberty, preconception counseling
should be routinely incorporated into diabetes care (e.g., at clinic visits)for all
women with diabetes of child-bearing potential".
- Are calcium and vitamins recommended along with folate? Did any of the
guidelines mention this?
-"Contraindications to pregnancy" is also considered on an individual basis in
consultation with their health care team.
- Did any of the guidelines recommend HbA1c less than or equal to 6%?
-
Level of interest: An article of importance in its field
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.