Nutritional Interventions and Lifestyle Changing in Gestational Diabetes Mellitus Prevention: A Narrative Review

Round 1

Reviewer 1 Report

Congratulations on your work. The article is quite interesting, follows the rules of the journal, is well-written and supports the title extensively.

I recommend some changes to improve the quality of the manuscript:

1.I suggest changing the title since in fact what you highlighted in the article is more appropriate to lifestyle changes (for example Nutritional intervention and lifestyle changing for GD prevention) 

2. please specify the weak points of your article

3. please include at the end some practical recommendations (lifestyle and nutrition)for preventing GD

4. you can also comment on the nutritional intervention for women without obesity/overweight but with the risk factors for GD

5. Finally, it is not clear what type of nutritional intervention is fitted/recommended for patients with a risk for GD, in the end, you recommend a healthy diet and nothing more. Can you be more accurate when regarding the type of diet, alcohol consumption, sleep behaviour and physical exercises(as your included studies did?

6.I recommend creating a figure with the proposed lifestyle management for women at GD risk. (not mandatory).

 

Author Response

Thank you for very helpful comments. 

1. I suggest changing the title since in fact what you highlighted in the article is more appropriate to lifestyle changes (for example Nutritional intervention and lifestyle changing for GD prevention) 

We are very appreciative of your suggestion, we modified it according to your recommendations. Nutritional intervention and lifestyle changing in gestational diabetes mellitus prevention: a narrative review

2. please specify the weak points of your article

Thank you for the comment, we added one paragraph in the Discussion section.

3. please include at the end some practical recommendations (lifestyle and nutrition)for preventing GD

Thank you very much, we modified accordingly in correlation with comment no 5, in the conclusion section.

4. you can also comment on the nutritional intervention for women without obesity/overweight but with the risk factors for GD

Thank you very much for this suggestion, we added some comments in the 3rd paragraph of the Discussion section.

5. Finally, it is not clear what type of nutritional intervention is fitted/recommended for patients with a risk for GD, in the end, you recommend a healthy diet and nothing more. Can you be more accurate when regarding the type of diet, alcohol consumption, sleep behaviour and physical exercises(as your included studies did?

Thank you for this comment. We included more clarifications in the conclusion section. Sleep behavior, alcohol consumption were not mentioned in the analyzed studies.

6.I recommend creating a figure with the proposed lifestyle management for women at GD risk. (not mandatory).

Thank you, for this recommendation. We added.

Reviewer 2 Report

Comments for author File: Comments.pdf

Author Response

Thank you for yours comments.

Abstract: R23 replace study with review and R26 add „observational” clinical studies.

Thank you ! We corrected them accordingly.

 Page 12 R185: reformulate „Processed eating pattern, defined by high intakes of processed meat and meat products, french fries, chips, chocolate, juice and soda both with and without sugar, green and root vegetables and potatoes.” (repeated „and” use).

Thank you ! We reformulated.

Page 15 R 335: reformulate „Although the risk of GDM is might be linked to improper vitamin D intake during the pregnancy, …” Discussion

Thank you ! We reformulated.

 R 370: reformulate „Types of dietary intervention were very heterogeneous from general counseling to adhere to healthier eating patterns, or to adopt a Mediterranean dietary pattern, or to choose low glycaemic index foods, to dietary advice focusing on increasing consumption of some food groups or vitamin D or probiotics supplementations”

Thank you ! We reformulated.

R460: the results of Yap et all are repeated here. Consider comparing your main recommendation after reviewing the literature with other reviews. For example, other meta-analysis showed that vitamin D supplementation during pregnancies with GDM significantly improved glycemic control (Li, Dandan et al. “The effects of vitamin and mineral supplementation on women with gestational diabetes mellitus.” BMC endocrine disorders vol. 21,1 106. 24 May. 2021, doi:10.1186/s12902-021-00712-x), while others did not (Rodrigues, Meline Rossetto Kron et al. “Efficacy of vitamin D supplementation in gestational diabetes mellitus: Systematic review and meta-analysis of randomized trials.” PloS one vol. 14,3 e0213006. 22 Mar. 2019, doi:10.1371/journal.pone.0213006).

We are highly appreciative of your suggestion. We modified the paragraph, including other reference as the suggested meta-analyses referred to pregnant women already having GDM.

Reviewer 3 Report

General

-It seems that the covered topic is out of the scope of Sustainability. I think it would be more appropriate for Nutrients or IJERPH

Title

-I suggest indicating within a title that this paper is a review, not research paper.

Introduction

-Line 40 – there is a literal error – “is” instead of “mis”.

-Line 54 – “are” instead of “is” because it refers both to obesity and metabolic syndrome.

-Lines 56-57 – I think Authors may present here the exact prevalence of GDM in the specific regions in the world.

-Line 67 – the term “T2DM” appears here for the first time, so it must be explained.

-Line 93 – Authors write that “The present study aims to realize an update about different types of nutritional interventions in prevention of GDM.” If this is an update, it would be worth mentioning what were the results of previously conducted systematic reviews concerning the assessment of the effectiveness of dietary interventions in prevention of GDM.

Materials and Methods

-I have some major comments regarding applied methodology:

-          In my opinion Authors used too few keywords to find appropriate articles (for example they you didn’t use such keywords as “dietary intervention”, “dietary approach”. As a result, many articles meeting inclusion criteria may not have been found.

-          Why did Authors set one of the inclusion criteria as women > 18 years? All in all 16- or 17-year old girl may be pregnant as well. Even WHO indicates women of reproductive age as women

-          Why did Authors focus only on women in the second trimester? Even in the introduction you mention that GDM relates to the diabetes diagnosed in the second or third trimester.

-While conducting intervention studies one of the most important influencing the effectiveness of the intervention is its duration. So I would suggest indicating the time of each intervention in the table 1.

-Please add one more row in the table to describe the participants in each study.

-Table 1 – what does the abbreviation “Obs” stand for? I suppose it stands for observational study but you have to explain it.

Taking the above-mentioned objections into account, I suggest preparing some kind of systematic review but narrow it down to more specific topic, for example to focus on Mediterranean diet or DASH diet (as they were used as keywords) because in current form it may not involve all related articles due to not appropriately used keywords.

Author Response

Thank you for your comments, that which helped improving the quality of our article.

General

-It seems that the covered topic is out of the scope of Sustainability. I think it would be more appropriate for Nutrients or IJERPH

Thank you very much for your suggestion! Our review covers a health-care problem of great importance: gestational diabetes is the most common complication of pregnancy and through adequate nutritional intervention it might be preventable. Education, access to specialized care may improve not only pregnancy outcomes, but in the long term, other risks associated with gestational diabetes. Because of the implications in disease prevention, education and also potential economic cost saving aspects we thought that our review covers a health related problem of sustainability, so we submitted it here.

Title

-I suggest indicating within a title that this paper is a review, not research paper.

Thank you for your suggestion, we updated the title.

Introduction

-Line 40 – there is a literal error – “is” instead of “mis”. Thank you, we corrected.

-Line 54 – “are” instead of “is” because it refers both to obesity and metabolic syndrome. Thank you, we corrected.

-Lines 56-57 – I think Authors may present here the exact prevalence of GDM in the specific regions in the world. Thank you, we added the information.

-Line 67 – the term “T2DM” appears here for the first time, so it must be explained. Thank you. We explained.

-Line 93 – Authors write that “The present study aims to realize an update about different types of nutritional interventions in prevention of GDM.” If this is an update, it would be worth mentioning what were the results of previously conducted systematic reviews concerning the assessment of the effectiveness of dietary interventions in prevention of GDM.

Thank you very much for all the comments , we modified the text accordingly.

Materials and Methods

-I have some major comments regarding applied methodology:

-          In my opinion Authors used too few keywords to find appropriate articles (for example they you didn’t use such keywords as “dietary intervention”, “dietary approach”. As a result, many articles meeting inclusion criteria may not have been found.

      Thank you very much for this suggestion, we extended the research using those keywords and modified the section accordingly.

-          Why did Authors set one of the inclusion criteria as women > 18 years? All in all 16- or 17-year old girl may be pregnant as well. Even WHO indicates women of reproductive age as women

     It was a writing error, so we corrected it. But as general observation, only 2 studies included pregnant women over 16 years of age, most probably because the intervention in adolescents follows specific age related nutrition guidelines.

-          Why did Authors focus only on women in the second trimester? Even in the introduction you mention that GDM relates to the diabetes diagnosed in the second or third trimester.

Thank you. It was an omission, so we corrected it.

-While conducting intervention studies one of the most important influencing the effectiveness of the intervention is its duration. So I would suggest indicating the time of each intervention in the table 1.

Thank you, we updated the table so it included this parameter in the table.

-Please add one more row in the table to describe the participants in each study.

Thank you. We included this data in the table, but not as a distinct column because of page layout.

-Table 1 – what does the abbreviation “Obs” stand for? I suppose it stands for observational study but you have to explain it.

Thank you, we updated it.

Taking the above-mentioned objections into account, I suggest preparing some kind of systematic review but narrow it down to more specific topic, for example to focus on Mediterranean diet or DASH diet (as they were used as keywords) because in current form it may not involve all related articles due to not appropriately used keywords.

Thank you very much for your suggestion, we will take it into consideration for further work of our team, but the present paper aims to be a narrative review.

Round 2

Reviewer 3 Report

Authors have responded to all my objections and now I have no further remarks regarding the manuscript.