Motivating Pregnant and Breastfeeding Women in Spain to Avoid Persistent Toxic Substances in Their Diet

Round 1

Reviewer 1 Report

A very interesting study to determine the motivation of pregnant and lactating women to change their diet to avoid exposure to persistent toxic substances. 111 women living in Spain participated in the study. Experience in-depth analysis of questionnaires and the use of other instruments in the experiment showed that good health of a woman and a child and avoidance of diseases is a motivating factor. Demotivating factors for the protection of the health of both mother and child are also listed. The manuscript needs improvement in the description of the results and their presentation.

In the introduction there is a total chaos of information. It is important to emphasize the detrimental effect of persistent toxic substances on the health of the mother and child. The risk to pregnant women and to the development of the unborn child (fetus), as well as nursing women and the baby, must be taken into account. Persistent toxic substances are chemicals that accumulate in the body and have long-term effects, such as decreased fertility, cancer, etc.
The purpose of the work should be related to the title. It is interesting how many percent of women, when changing diets to avoid PTS, undertook physical activity.
Presentation of the results requires correction. The manuscript would be interesting if the authors presented the results as a percentage. They compared both studied groups of women.
I lacked information in the results which group of women included physical activity as a factor in avoiding persistent chemicals.
The discussion requires correction. What strategies have been taken for pregnant women to avoid PTS? (the aim of the work).

Comments for author File: Comments.pdf

Author Response

Thanks for the review of the manuscript:

- We have emphasized the detrimental effect of persistent toxic substances on health.

- We have included the role of physical activity in pregnancy.

- About methodology, although quantitative designs are commonly used in clinical research, some studies require qualitative methods. These designs are different from quantitative methods;. Setia MS. Methodology Series Module 10: Qualitative Research in Health. Indian J Dermatol. 2017; 62 (4): 367-370. doi: 10.4103 / ijd.IJD_290_17

- The strategies have been more developed

Reviewer 2 Report

Dear Authors,

The manuscript entitled ‘Motivating pregnant and breastfeeding women in Spain to avoid persistent toxic substances in their diet’(IJERPH989743) presented for review is very interesting and I recommend the article for publication in the International Journal of Environmental Research and Public Health but after major revision.

The topic of the article is relevant and interesting.

However, the manuscript should be improved in all sections.

Introduction

In section Introduction, the authors should enhance the text with the role of the correct nutrition of pregnant and breastfeeding women, and the errors which women usually doing.

The introduction does not demonstrate a gap in the literature on why this research should be conducted.

Material and Methods

Did women with the same financial status take part in the study? This could have influenced their approach to diet.

From this manuscript, I don’t know what the questions women were asked or which subjects were raised in interviews. Was it accidental statements or women filled the same forms? Was it only information from interviews and from focuses? In my opinion, this section of the manuscript should be improved.

The authors wrote that they were used Atlas -Ti7 computer program to encode the content of the discourses that obtained but in the manuscript, we can’t find results of compiling these results.

I don’t know which institution gave the authors Ethical Approval for this research.

Results

I believe that the authors collected much interesting information from women but in my opinion, the results didn't well described.

It should be statements/ tables from 111 women, but now it is only answers/ statements from chosen women. I am not sure, that the authors can conclude based on this information. In my opinion, this section of the manuscript should be improved.

Figure 1 should be improved because it is of bad quality.

Conclusions are quite enigmatic.

References

References are not cited according to the rules of the journal.

Although the authors used 50 references, they don't use many new articles connect with this subject, for example:

1. Zielińska A., Hamulka J.: Protective Effect of Breastfeeding on the Adverse Health Effects Induced by Air Pollution: Current Evidence and Possible Mechanisms. Int. J. Environ. Res. Public Health 2019, 16(21), 4181; https://doi.org/10.3390/ijerph16214181.
2. Zielinska MA, Hamulka J.: Reason of non-exclusive breastfeeding to infants within the first 6 months. Pediatr Int. 2018, 60, 3, 276-281. DOI: 10.1111/ped.13480.
3. Zielinska M.A., Hamulka J., Wesolowska A.: Carotenoid Content in Breastmilk in the 3rd and 6th Month of Lactation and Its Associations with Maternal Dietary Intake and Anthropometric Characteristics. Nutrients 2019, 11(1), 193. doi.org/10.3390/nu11010193.

I believe, that this manuscript is a valuable source of information about motivating pregnant and breastfeeding women for their improved diet, but authors should be improved the manuscript because in this form is not clear that they researched and what results from their achievement.

Reviewer

 

Author Response

Thanks for the review of the manuscript: 

- We describe adequate nutrition in pregnancy.

- The quality of figure 1 has been improved Figure 1

- Suggested citation has been included

- The references have been adapted to the format of the journal

Reviewer 3 Report

The main of this study was to analyze the impact of persistent toxic substances on the lives of pregnant and breastfeeding women. The authors report that one of the key factors that leads to dietary change is concern about one’s health and the health of the offspring. Another key factor is avoiding harm and illness.

Author Response

Thanks for the review of the manuscript

Round 2

Reviewer 2 Report

Dear Authors,

The manuscript entitled ‘Motivating pregnant and breastfeeding women in Spain to avoid persistent toxic substances in their diet’(IJERPH989743) presented for review was corrected.

The authors have changed many parts of the planned paper according to my suggestions. I would like to thank the authors for considering my comments and applaud them for the revisions to improve their manuscript.

The introduction was corrected and supplemented.

I still don't know if the women with the same financial status took part in the study? This could have influenced their approach to diet. Maybe, this is the limitations of these results.

References were supplemented but references still don’t cite according to rules of the journal (Please refer to the journal requirements).

In this form, I accept the manuscript, but the authors should improve the technical status of the article.

Reviewer