Title: Behavior changes to promote preconception health: A systematic review
Version: 0 Date: 20 Oct 2024
Reviewer's report:
This is a well-written manuscript, congratulations to the authors.
The below comments are to improve the usefulness of findings and put them in context with
current literature.
Background
1) There is currently a lack of consensus regarding preconception guidelines, this is worth
mentioning in the background as it may explain why the studies presented measure biomedical
outcomes (diet, exercise) however do no expand to psycho-social measures such as mental health
which is now listed as an important factor to consider when planning a family. I would suggest
looking and including this citation: Dorney, E., Boyle, J. A., Walker, R., Hammarberg, K.,
Musgrave, L., Schoenaker, D., ... & Black, K. I. (2022, July). A systematic review of clinical
guidelines for preconception care. In Seminars in Reproductive Medicine (Vol. 40, No. 03/04,
pp. 157-169). Thieme Medical Publishers, Inc..
2) The background does not include literature on modifiable  behavior change  and the evidence
to support  - please include the importance of the use of theory and frameworks to justify why
it is important to use BCT.  You could have a look at the following paper as it discusses this in
relation to  BCT and preconception apps; Musgrave, L., Cheney, K., Dorney, E., Homer, C. S.,
& Gordon, A. (2023). Addressing preconception behavior change through Mobile phone apps:
systematic review and meta-analysis. Journal of Medical Internet Research, 25, e41900.
3) Line 70 - please update to include vaping and e-cigarettes as these are also important lifestyle
changes
4) Please note in the background that public health messaging is important as only  about 30-50%
of women will plan a pregnancy and so everyone of reproductive age should have PPC including
those inter conception.
Methods
1) I am concerned that the search strategy did not include words such as inter conception or
family planning and that because these were not included words this review may have missed
some eligible studies. Please re-run the search with these words or rationalise why you did not
use these common PPC words.
2) Please provide rationale as to why those studies with participants undergoing fertility
treatment (line 99) were not included as this would be the bulk of people trying to improve BC.
Likewise, please provide a more in depth why vaccination and supplementation studies were
excluded (line 100-101)
3) Line 112 - Rayyan software should have a copywrite symbol.
Results -
1) Line 158 - please remove  'multiple choice'  or expand on relevance of this .
2)More information about the interventions is required. Please expand on  'web-based
education" (was this interactive or simply information, if just information this will not change
behavior and therefore should not be included). Also, 'informational campaigns', what did this
consist of? Social media, billboards -again link to behavior change.
3)Page 15 and 17  - there are 2 sections that can be combined - they have the same headings
Group education and Individual and group education.
4) Please be more specific (line 314) ' commercial marketing technologies - what is this? Social
media, television, free give aways, gamification???
Discussion -
1) The discussion needs some work as it currently just reiterates what the results say. Please
comment on how your findings are similar or dissimilar to other reviews and place your work in
context with other reviews. For example, you have not included a  recent review that looked at
behavior change interventions delivered via mHealth, you mention this intervention and it it very
topical however you have not discussed it. This shows that a complete search of the literature
was not conducted. Here is the citation: Musgrave, L., Cheney, K., Dorney, E., Homer, C. S.,
& Gordon, A. (2023). Addressing preconception behavior change through Mobile phone apps:
systematic review and meta-analysis. Journal of Medical Internet Research, 25, e41900.