PONE-D-20-29604

Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States

PLOS ONE

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Vijayaprasad Gopichandran

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The current manuscript aims at investigating whether the change in an exercise routine during the Covid-19 pandemic is associated with the prenatal depression scores in pregnant women in the United States. Moreover, the current study also aims to investigate whether women in metro areas (urban) are more likely to report changes in exercise routines as compared to those in the non-metro areas. The authors collected data from an online survey of pregnant women in the United States. A total of 1,862 responses were collected. The findings revealed that women reporting exercise changes during the pandemic also reported significantly higher depression scores compared to those reporting no changes. Additionally, women living in metro areas were significantly more likely to report exercise changes compared to women living in non-metro areas. The authors suggested that an association between the change in an exercise routine and depression scores exist. They concluded that moderate exercise may represent a non-pharmaceutical tool for supporting maternal physical and mental health.

An adequate background about the association between the physical activity and mental health of pregnant women is provided, although the question of pandemic related exercise changes and mental health in pregnant women is relatively new. The manuscript is well written, and the study is interesting. Overall, the writing is coherent and concise.

The data set is quite large and collected from all across the United States. The methods and data analysis are clear and thorough. The methods are well-written and extensively explained. The results and data interpretation are clear and interesting. The objectives are met and the conclusions are supported by the data provided.

Discussion is clear and leaves the reader with a good understanding of how changes in an exercise routine have an influence on mental health of pregnant women and also provides future considerations. Finally, the authors suggested that the exercise routine (moderate aerobic exercise) can serve as a non-pharmaceutical treatment in order to avoid the harmful exposure of offspring to psychotropic medications taken by mother during pregnancy.

Overall, the manuscript is well written and strong, and adds to the existing literature of Covid-19 and mental health.

Reviewer #2: The abstract is clear and well explained. All sections are well presented.

The introduction section provides background information on COVID-19 situation and its impact in the world and describes how COVID-19 has posed a risk to pregnancy. It also explains the mental status of pregnant women during the COVID-19 pandemic. Necessary evidences have been discussed. It also discusses the elevation of maternal depression during the epidemic and the use of alternative methods for its treatment which includes regular exercise. Overall the introduction section is well described.

The material and methods section is divided into different subsections. The design has been explained well along with description of all the variables used. It also explains the use of data from the CARE study. The statistical analysis are also fine.

The results are described sufficiently. The characteristics of the participants are well described. Tables have been presented to show the descriptive characteristics. Linear regression analysis has been used to test the hypothesis. Results are fine.

The discussions are sufficient and supports the findings made from the study.

The limitations of the study is also well presented.

The conclusions are in line with the findings and the discussions made.

References are valid and sufficient.

Reviewer #3: The article contains a lot of useful information on the issue. The topic is very interesting and use of sources is appropriate. Some revisions are necessary: The aim of the study is clear, the title is informative and relevant, but the abstract section involve too much information. The authors should not write such details about their manuscript. As regards the references, are relevant, but not so recent, referenced correctly, and there are appropriate key studies included. However, the authors should add some more, in order to establish their findings.

Introduction/ background

It is quite clear what is already known about this topic and the research question is clearly outlined. The research question is not justified clearly, given what is already known about the topic. Some chapters are lengthy related to others. The authors have to keep uniformity about the length of the chapters.

Overall

The article contains a lot of useful information and the topic is very interesting. Some revisions are necessary: The author should provide more information in some chapters and omit some others. In addition, they should conclude a chapter with the limitations of the studies mentioned.

Reviewer #4: GENERAL:

The authors have presented data, which is very poignant at this time, therefore I encourage the authors to revise and resubmit.

1. Is the manuscript technically sound, and do the data support the conclusions? Until the clearly state why they have chosen logistic regression, it cannot be determined. Also, as is pointed out in the attached PDF, the hypotheses are formally stated; hence, the results/conclusions do not flow from the hypotheses and analyses.

2. Has the statistical analysis been performed appropriately and rigorously? The authors do test the underlying conditions for the logistic regression, however, as mentioned above in #1., until the authors justify the test, this cannot be determined.

3. Have the authors made all data underlying the findings in their manuscript fully available? The authors have explained.

4. There are a few grammatical errors. See attached PDF. In general, proofing is needed.

ALSO:

SPECIFIC RECOMMENDATIONS

Title:

1.Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States – suggested: “Exercise routine change is associated with prenatal depression during the COVID-19 pandemic among pregnant women in the United States”

Abstract:

1.Methods: Kindly place all in past-tense “used” instead of “uses”; insert “reported” before “COVID-19-related”

2.Conclusions do not follow from hypotheses.

Background:

-Sentence requires a citation—line 97, “given the effects of shelter in place orders”, can be qualified with U.S. data as of the writing of the manuscript. i.e. the number of states with or without shelter in place / stay at home orders, etc.

-Please include a justification for all of your covariates in the background, e.g. age,

Methods:

What is stated, is a more general wording of the hypotheses, which should be included earlier on – in the Abstract as well as at the end of the Introduction:

“Hypothesis 1: Linear regression analyses assessed whether exercise routine change during the

170 COVID-19 pandemic was significantly associated with participant depression score.

171 Hypothesis 2: Logistic regression analyses tested whether a participant RUCC classification of

172 “metro” was linked with significantly higher odds of reporting an altered exercise routine during the

173 pandemic compared to a classification of “non-metro”.

Please review how hypotheses should be stated, and re-state the hypotheses more formally here in the Methods section.

Statistical Analysis

Inform the audience by explaining why LR is the most appropriate test, with citations from a methods book or published article.

Results:

Hypotheses must be accepted or rejected.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Dr. Kalliopi Megari

Reviewer #4: Yes: Lunthita M. Duthely, Ed.D.

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Attachments

Attachment

Submitted filename: Review comments.docx

Attachment

Submitted filename: AAA-PONE-D-20-29604_reviewer-110720.pdf

Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States

PONE-D-20-29604R1

Dear Dr. Gildner,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Vijayaprasad Gopichandran

Academic Editor

PLOS ONE

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Reviewers' comments: