Sociodemographic, Lifestyle, Environmental and Pregnancy-Related Determinants of Dietary Patterns during Pregnancy

Round 1

Reviewer 1 Report

The manuscript  Sociodemographic, Lifestyle, Environmental and  Pregnancy-related Determinants of Dietary Patterns  during Pregnancy is well written and the cohort study is well conducted, however there are some issues that should be considered:

1. in the introduction session lifestyle factors are discussed however Environmental Pollutants (or substances that are thought to cause endocrine disruption), and sleep are other two important factors that the authors should consider.

2. Supplement use, is a factor that shows motivation in pregnant women to stick to a healthy lifestyle. Has it been considered?

3. In the session Study Design and Population, although the authors state that the study has been presented elsewhere (citing references). I agree that  if the reader is interested in the details, he or she will read the original but  in my opinion the reader is interested to find a summary of the main criteria used to enroll the sample (ex: specific criteria for diet or food selection due to personal, ethical choices or diseases)  without going back to read what has already been published elsewhere, making results more comprehensible.

4. In the session Food Frequency Questionnaire the authors should detail better if  the questionnaires have been filled by the women themselves o with the help of a professional? In this case was a skilled professional (ex a dietician) or what? Has he/she received some specific training?

Was it just a qualitative or a semiquantitative FFQ? Were the subjects enrolled helped with illustrations for portion sizes ?

5. In the session Sociodemographic, lifestyle, environmental and pregnancy-related factors, did the authors consider weight gain during pregnancy?

6. In the session Characteristics of the study population was there any Women Undergoing Assisted Reproduction Procedures?

7. Lines 299-300 : 

this should be explained by discussing the under reporting which is common to many "categories" of women during lifespan, especailly those who know should pay attention becuase already counselled on diet. 

See:

De Giuseppe R, et al. Dietary underreporting in women affected by polycystic ovary syndrome: A pilot study. Nutr Diet. 2018 Aug 5. doi: 10.1111/1747-0080.12460. [Epub ahead of print] PubMed PMID: 30079594; PubMed Central PMCID: PMC6363911.

Cena H, et al. Underreporting in obese inpatients undergoing a psycho-nutritional rehabilitative program. Eat Weight Disord. 2013 Jun;18(2):199-207. doi: 10.1007/s40519-013-0018-y. Epub 2013  Apr 9. PubMed PMID: 23760849.

 Mendez CA et al,  Alternative methods of accounting for underreporting and overreporting when measuring dietary intake-obesity relations. Am J Epidemiol. 2011 Feb 15;173(4):448-58. doi: 10.1093/aje/kwq380. Epub 2011 Jan PubMed PMID: 21242302; PubMed Central PMCID: PMC3139974.

 Macdiarmid J, Blundell J. Assessing dietary intake: Who, what and why of under-reporting. Nutr Res Rev. 1998 Dec;11(2):231-53. doi: 10.1079/NRR19980017. PubMed PMID: 19094249.

8. Lines 319-321. Among the confounding factors also  number of family members and SES should be considered.

9. Lines 333-335:The authors here state that  "It is also worth noting the study inclusion criteria, i.e. only 333 healthy women (without diseases as specified by the study protocol such as diabetes mellitus, 334 hypertension) in healthy pregnancy, which in principle means that women not requiring special diets 335 were the subjects of this analysis." (see comment # 3)

Besides here authors should also mention if they have considered selector eaters or vegetarians? were they included or not?

10. 359-359 Here authors state that "We also noticed that the pre-pregnancy overweight/obese women selected a healthier diet during pregnancy, which might indicate that pregnancy stimulated them to introduce dietary changes"

This is just a speculation since they all could be  under-reporters?

Minor revisions:

line 95 change developing fetus  in influencing fetus 

line 59 understand needs the passive form

line 67 recommend need the past form

FFQ, state here if it was previously validated (even if you explain it later)

Author Response

Dear Reviewer,

Thank you for all your work on our manuscript “Sociodemographic, Lifestyle, Environmental and Pregnancy-related Determinants of Dietary Patterns during Pregnancy".

 

Your comments and suggestions were very useful and helped to improve the paper considerably.

All your suggestions have been taken into account in the recent revision of the manuscript.

 

You can find answers to your specific comments in attached document.

Best regards

Kinga Polanska

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for the opportunity to review this methodologically rigorous paper. As the authors point out, there is a need to identify factors that influence dietary choices, especially during pregnancy, to inform the development of effective public health interventions. The aim of the study was to evaluate the socio-demographic, lifestyle, environmental and pregnancy-related determinants of maternal dietary patterns in a sample of 1306 2^nd trimester women from the Polish Mother and Child Cohort, through the means of exploratory factor analyses and multiple linear regressions. The strengths of the study rely in its large sample size, the combination of self-reported and biomarker measurements, and the evaluation of a comprehensive list factors that might influence dietary patterns during pregnancy.

I have only a few comments, which could hopefully help enhance the manuscript.

1. Although the design of the cohort was presented elsewhere, I believe the readers should be able to read summary information on the eligibility criteria, the data collection timeframes, and setting.

2. Was the use of supplements during pregnancy taken into consideration when assessing dietary patterns? This could impact dietary patterns during pregnancy.

3. Authors mention the assessment of pre-pregnancy BMI, but do not take into account pregnancy weight gain. Also, it would have been good to account for women’s management of gestational weight gain with the aim to return to their pre-pregnancy weight as soon as possible after childbirth. This could significantly influence dietary patterns.

4. The statistical analysis is sound and based on educated deductions (i.e. factor loadings cut-offs). I especially appreciated the fact that the Authors went the extra mile and computed the alternative logistic regression model to support their findings.

5. The findings regarding the environmental factors are not at all approached in the Discussion section

Author Response

Dear Reviewer,

Thank you for all your work on our manuscript “Sociodemographic, Lifestyle, Environmental and Pregnancy-related Determinants of Dietary Patterns during Pregnancy".

 

Your comments and suggestions were very useful and helped to improve the paper considerably.

All your suggestions have been taken into account in the recent revision of the manuscript.

 

You can find answers to your specific comments in attached document.

Best regards

Kinga Polanska

Author Response File: Author Response.pdf