Pregnant women’s daily patterns of well-being before and during the COVID-19 pandemic in Finland: Longitudinal monitoring through smartwatch technology

Hannakaisa Niela-Vilén; Jennifer Auxier; Eeva Ekholm; Fatemeh Sarhaddi; Milad Asgari Mehrabadi; Aysan Mahmoudzadeh; Iman Azimi; Pasi Liljeberg; Amir M. Rahmani; Anna Axelin

doi:10.1371/journal.pone.0246494

Peer Review History

Original SubmissionOctober 13, 2020
25 Nov 2020 Decision Letter - Kelli K Ryckman, Editor PONE-D-20-32152 Pregnant women’s daily patterns of well-being before and during the COVID-19 pandemic in Finland: longitudinal monitoring through smartwatch technology PLOS ONE Dear Dr. Niela-Vilen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 09 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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 ****** 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 ****** 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: Pregnant women’s daily patterns of well-being before and during the COVID-19 pandemic in Finland: longitudinal monitoring through smartwatch technology This study examines two cohorts of pregnant women (N=38), whose PPG, sleep and physical activity data were collected over four week periods before and during national stay-at-home restrictions in response to the COVID-19 pandemic. Overall, the writing is straightforward and a rationale for the study is clear and relevant. There are several points at which the authors could improve the clarity of the methods as well as their interpretation of the findings. It is unclear for what type of overall study these women were recruited and that could be made more apparent. In terms of the device used to collect the data, it might be helpful to know whether this device has been validated or used for research purposes or to mention earlier than in the limitations section. The authors also include both high and low risk women in this sample and report demographics and mean EPDS and anxiety scores. This has the potential to confound some meaningful data. First, the authors might add validity to their approach by showing statistically that these two groups do not differ in meaningful ways across demographics and clinical characteristics. They might also add these analyses to their outcomes, as there may be distinct differences in the overall stress of women who are high-risk and women who are low-risk in this sample and those differences may be observed in both HRV and sleep. If these groups are statistically no different, than these findings are valid. If not, there is an issue here of examining qualitatively distinct groups that are better off being examined separately. Alternately, the authors can explain their rationale in including all of these women in the same study via providing more context for the overall study (specifics that are aforementioned in this review). The authors find that SDNN increased across time despite the LF and LF/HF ratio increasing. These results are somewhat counter to one another, but the author discusses this as if there is a linear relationship between stress and HRV (starting in line 340). It might be more helpful to discuss this counterintuitive finding considering what aspects of autonomic functioning contribute to SDNN vs LF HRV ( see Shaffer & Ginsberg, 2017 for a broad but meaningful overview). In fact, HRV may become blunted or hypoactive in the face of acute stressors In this sample, it is possible that there may be other clinical factors at play (increases in depression or anxiety or event symptoms of PTSD) that might impact parameters of HRV in either the time or frequency domains. The authors do not control for any other factors related to HRV, including weight or physical health and it is incredibly difficult to draw conclusions related to HRV without controlling for these factors or holding other factors consistent, including time of day when the data was extracted. The authors might do well to refer to major papers that discuss these recommended methods directly and include these potential confounders in their paper if they have them or address them as limitations if they do not (Laborde, Mosley & Thayer, 2017). While I agree that this article has merit, the oversight in terms of psychophysiological data analyses and interpretation is hard to ignore. Laborde, S., Mosley, E., & Thayer, J. F. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research–recommendations for experiment planning, data analysis, and data reporting. Frontiers in psychology, 8, 213. Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in public health, 5, 258 ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0246494.r001
Revision 1
18 Dec 2020 Author Response Responses to the Editor and the Reviewer Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf RESPONSE: We have used the given templates and followed the PLOS ONE’s style requirements throughout all the files. 2.Please provide the following information in your Methods section regarding validation of the weekly question asked related to the COVID-19. RESPONSE: The weekly questions were developed for this study and therefore not validated. We have added this information in the Methods section. 3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. RESPONSE: We have revised the cover letter accordingly. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. RESPONSE: We do not have any Supporting information files in our submission. Review Comments to the Author Reviewer #1: Pregnant women’s daily patterns of well-being before and during the COVID-19 pandemic in Finland: longitudinal monitoring through smartwatch technology This study examines two cohorts of pregnant women (N=38), whose PPG, sleep and physical activity data were collected over four week periods before and during national stay-at-home restrictions in response to the COVID-19 pandemic. Overall, the writing is straightforward and a rationale for the study is clear and relevant. RESPONSE: We would like to thank the Reviewer for the positive and constructive criticism provided. Our detailed responses to the questions and concerns below. The changes in the manuscript text are made with “track changes”. There are several points at which the authors could improve the clarity of the methods as well as their interpretation of the findings. It is unclear for what type of overall study these women were recruited and that could be made more apparent. RESPONSE: We have added more detailed description of the overall study where these women were recruited in the Study design paragraph. In terms of the device used to collect the data, it might be helpful to know whether this device has been validated or used for research purposes or to mention earlier than in the limitations section. RESPONSE: We have added a sentence about the validity of the smartwatch in the beginning of the Data collection paragraph. In addition, we modified the text regarding validity in the Limitations section. The authors also include both high and low risk women in this sample and report demographics and mean EPDS and anxiety scores. This has the potential to confound some meaningful data. First, the authors might add validity to their approach by showing statistically that these two groups do not differ in meaningful ways across demographics and clinical characteristics. They might also add these analyses to their outcomes, as there may be distinct differences in the overall stress of women who are high-risk and women who are low-risk in this sample and those differences may be observed in both HRV and sleep. If these groups are statistically no different, than these findings are valid. If not, there is an issue here of examining qualitatively distinct groups that are better off being examined separately. Alternately, the authors can explain their rationale in including all of these women in the same study via providing more context for the overall study (specifics that are aforementioned in this review). RESPONSE: We have added the background characteristics of both high-risk and low-risk groups separately in the Table 1. There were no differences between the groups except the gestational weeks during the study period since the recruitment of the participants in the high-risk group was initiated and completed earlier. However, we used the group also as an independent variable in the statistical models to confirm there were no differences between these groups. The authors find that SDNN increased across time despite the LF and LF/HF ratio increasing. These results are somewhat counter to one another, but the author discusses this as if there is a linear relationship between stress and HRV (starting in line 340). It might be more helpful to discuss this counterintuitive finding considering what aspects of autonomic functioning contribute to SDNN vs LF HRV ( see Shaffer & Ginsberg, 2017 for a broad but meaningful overview). In fact, HRV may become blunted or hypoactive in the face of acute stressors In this sample, it is possible that there may be other clinical factors at play (increases in depression or anxiety or event symptoms of PTSD) that might impact parameters of HRV in either the time or frequency domains. The authors do not control for any other factors related to HRV, including weight or physical health and it is incredibly difficult to draw conclusions related to HRV without controlling for these factors or holding other factors consistent, including time of day when the data was extracted. The authors might do well to refer to major papers that discuss these recommended methods directly and include these potential confounders in their paper if they have them or address them as limitations if they do not (Laborde, Mosley & Thayer, 2017). While I agree that this article has merit, the oversight in terms of psychophysiological data analyses and interpretation is hard to ignore. Laborde, S., Mosley, E., & Thayer, J. F. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research–recommendations for experiment planning, data analysis, and data reporting. Frontiers in psychology, 8, 213. Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in public health, 5, 258 RESPONSE: Thank you for pointing this out. We have now modified the Discussion section in order to emphasize the challenges in interpreting the HRV results. We were not able to control all the confounding variables, however, we used only night-time data thus the day of the time was controlled. The Limitations section has also been modified to provide a clear picture of which parameters were controlled and which not. Further, we have added the papers the Reviewer suggested in the discussion and found them very relevant and useful for our manuscript. ________________________________________ Attachments Attachment Submitted filename: ResponsestotheReviewers.docx https://doi.org/10.1371/journal.pone.0246494.r002
20 Jan 2021 Decision Letter - Kelli K Ryckman, Editor Pregnant women’s daily patterns of well-being before and during the COVID-19 pandemic in Finland: longitudinal monitoring through smartwatch technology PONE-D-20-32152R1 Dear Dr. Niela-Vilen, 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. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Kelli K Ryckman Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. 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 ****** 5. 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 ****** 6. 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: Point by point, the authors have appropriately addressed comments offered and integrated this reviewer's suggestions appropriately. I think this paper makes a contribution to the field in regards to the limited knowledge that we have about psychophysiology during the perinatal period. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No https://doi.org/10.1371/journal.pone.0246494.r003
Formally Accepted
25 Jan 2021 Acceptance Letter - Kelli K Ryckman, Editor PONE-D-20-32152R1 Pregnant women’s daily patterns of well-being before and during the COVID-19 pandemic in Finland: longitudinal monitoring through smartwatch technology Dear Dr. Niela-Vilen: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Kelli K Ryckman Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0246494.r004

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