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:3 November 2014
Reviewer: Kara A Michels
Reviewer's report:
This research covers an interesting and important topic, but there is need for
clarification of purpose and improvement in the methods.
Major Compulsory Revisions
1. Please clarify the main purpose of this research and objectives for the
analyses. Is the authors’ goal to describe all preconception interventions done
among women with chronic diseases? If so, why exclude studies reporting on
only pregnancy or birth outcomes, if those studies were done among women with
chronic diseases? What is the end goal of intervention that the authors are
commenting on? How chronic disease affects women’s perceptions of,
experiences with, and adherence to interventions? Improvement of the original
maternal chronic disease? Less chronic disease in children of women with
chronic disease? What are these studies intervening on?
The literature search criteria need to explained and possibly revised:
2. What other chronic diseases could be added to the search terms (lines
99-101)? Why was this the authors’ final list? Perhaps the authors could clarify
what is meant by chronic disease in their review (e.g., ones that are better
targets for behavioral interventions). Related to my first comment, the authors
could consider expanding or narrowing the search terms (e.g., focus on
interventions among diabetic women and then commenting on the adherence,
experiences, or improvement in BMI/biomarkers, pregnancy outcomes, child
health, etc.)
3. Also, why limit to studies using “comprehensive preconception clinical care
services?” What is meant by comprehensive services? Most interventions have
specific goals or narrower scopes (e.g., dietary education).
4. Why was the search limited to 2003-2013 and not earlier? And I hate to say
this, but the search could be updated for more recent articles too (this might not
be too difficult, as no meta-analyses were preformed).
5. Please clarify the inclusion/exclusion criteria described in line 110. As the
review process is described now, this does not appear to be a systematic
literature review. Language similar to that used to describe the quality rating
systems should be used to describe the inclusion/exclusion processes.
6. The language throughout could be clarified—shorter sentences, using
semi-colons or m dashes, cutting word clutter, watch for repetitive words, clear
flow within paragraphs/sections. Some examples are:
Line 73: Could remove the word “maternal”
Line 74: Remove “on”
Line 81: Change “have attempted to inform the development of” to “attempted to
develop.” Also what do the authors mean by “commentators?”
“et al” should be “et al.”
Consider removing “pregestational” in lines 72 and 162. Could say
preconceptional/“pre-existing” /”diabetes”/or the type to make it distinct from
gestational diabetes. Check the document to make sure consistent use of
hyphenation for words like “pregestational” or “pre-gestational” is used.
Minor Essential Revisions
7. I would like to read actual results from the authors review in the “results”
section of the abstract; it currently reads a bit like a table of contents.
8. Some room for clarification: perhaps lines 52-55 can be broken into two
sentences. The list is a little confusing now and implies that the fetal environment
impacts the health of the mother.
9. Lines 54-57: Do the authors refer to the fetal environment impacting future
reproductive outcomes? Perhaps this could be shortened to describe just the
chronic conditions (the focus of the review) and explain what specifically in the
fetal environment is linked to later chronic conditions. (i.e., tie this in with the
sentence that follows in the text).
10. Lines 89-92: Reproductive Medicine has very recently published a
supplement of preconception intervention reviews—including one on chronic
disease interventions (see Lassi et al.; doi: 10.1186/1742-4755-11-S3-S5). The
authors should consider reading these and incorporating any relevant
findings/comparisons in their text. Should remove the phrase “first review” from
throughout the text and describe what their review specifically adds to the
literature.
11. Line 122: Recall bias is not the inability to remember past events per se, but
rather the differential memory of participants based on knowledge of their
disease or some other factor.
12. Line 125: The discussion of power and sample size criteria is confusing.
Might sample size depend on the effect one is trying to detect and therefore be
specific to what is known about each disease/intervention? Is this what lines
126-128 are commenting on?
13. Line 129: What does “reporting of thematic saturation” mean? Much of the
commentary in lines 128-132 reads like it was taken from a textbook and needs
clarification.
14. Line 145: What are the domains and areas of interest? The “themes (line
148)?” These need to be described in text.
15. Why is the paper by Griffiths et al. (2008) included if it was performed among
pregnant women? Were they measuring health in subsequent pregnancies?
(Table 3)
16. The results categories in the review are nice (knowledge, attitudes, etc.), but
might be more effective if the overall purpose of the review were more clearly
defined and the previously mentioned grammar/language issues improved. Also,
make clear from the beginning whether or not the focus of this review is
experiences with preconception care, rather than health outcomes (this is how it
seems to me; see my first comment).
17. Line 309: The authors state that current studies are not generalizable, yet
have not adequately described why in the text. (e.g., population demographics,
etc.)
18. Line 301: Clearly define “nationally representative” (i.e., Australia). Also, what
is unique about the authors’ country in the context of preconception care? Aside
from few studies done in their country, why are the authors calling for more
studies there? (e.g., high rates of chronic disease, insurance coverage for
behavioral interventions, etc.)
19. Line 326: Change intraconception to interconception
20. Acknowledgements: Was there any relevant funding for this study or
researchers working on it that should be mentioned?
21. Table 2 needs footnotes to describe what the letters mean.
Discretionary Revisions
22. The discussion section seemed too long; there is room for streamlining,
improving clarity, and even moving some discussion to the results section. Also
could spend less time on the “next steps” information.
23. 67 references seems like too many (when only a dozen are the reviewed
articles), but this is possibly due to the paper needing a more clearly defined
focus (possibly a narrower one), as I mentioned earlier.
24. I really liked the authors’ point: “…improved consideration of temporal
changes to women’s health behavior…”, but felt more time could be spent on this
idea.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
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.