Comment on: The experience of pregnancy in the COVID-19 pandemic

I read with interest the article by Lopes et al. entitled "The Experience of Pregnancy in the COVID-19 Pandemic".(¹) The topic is timely and important, and the authors deserve appreciation for exploring various maternal experiences in such a complex context. However, I would like to respectfully draw attention to some methodological and scientific issues that could compromise the validity and interpretation of the work.

First, the sample was limited to women who were receiving care in private facilities, and most of them had higher incomes and levels of education. In a nation with significant health disparities, this creates socioeconomic homogeneity, which significantly reduces the study's representativeness. Furthermore, the scope is further limited and selection bias is done by excluding postpartum women who tested positive for COVID-19, who are arguably one of the most affected categories.

Second, even though the authors say they employ Krippendorff's Content Analysis,(²) this approach is more commonly linked to quantitative coding schemes and isn't the best fit for the study's subjective investigation. Additionally, there is a gap between the suggested and implemented approaches since the method's analytical features like dendrograms are missing.

Third, without using methodological safeguards like data triangulation or saturation tracking, which are crucial for qualitative rigor, the study makes a number of claims regarding the pandemic's effect on pregnancy experiences. The reliance on virtual interaction as a common factor was discussed with insufficient attention to Brazil's digital divide, which may have left out important viewpoints.

Lastly, although the research finds that its findings are consistent with those of other studies, it fails to consider Brazil's distinct maternal health system structure, which may have a significant impact on experiences across various socioeconomic strata. I believe these issues warrant clarification to avoid misinterpretation and to uphold the scientific rigor expected of publications in RBGO. With regard to study design and representation in prenatal mental health studies, I believe my letter makes a positive contribution to the current conversations.(¹)

References

• ¹ Lopes MC, Beck CT, Rosa ZH, Abuchaim ES. The experience of pregnancy in the COVID-19 pandemic. Rev Bras Ginecol Obstet. 2025;47:e-rbgo8. doi: 10.61622/rbgo/2025rbgo8
  » https://doi.org/10.61622/rbgo/2025rbgo8
• ² Krippendorff K. Content analysis: an introduction to its methodology. 4th ed. Thousand Oaks: Sage; 2019.

Author's reply to comment on: The Experience of Pregnancy in the COVID-19 Pandemic

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

We appreciate the reader's feedback on our article, which was based on research guided by professors from the Federal University of São Paulo and the University of Connecticut. The study aims to reveal women's experiences of pregnancy during the COVID-19 pandemic.

The authors acknowledge the socio-economic and cultural disparities faced by pregnant and postpartum women in Brazil. The vast majority of studies on the experience of Brazilian women regarding care and/or living in the pregnancy-puerperal cycle are carried out in public health services, a situation that can also be considered a limitation. The opportunity to understand the experiences of women receiving assistance in private health institutions is particularly significant, especially during the pandemic when concerns about insufficient knowledge, human resources, materials, and technical support were major stress factors. The pandemic has impacted women from all social strata. During this period, the significance attributed to this experience is unique, as the institution restricted contact with infected women due to isolation measures and local restrictions. Therefore, we conducted interviews with postpartum women hospitalized in the postpartum room.

As the objectives are clarified for the reader regarding the nature of the study, two theoretical and methodological references are provided. The demonstration (including limitation, vision, and representation), the presentation of the results, and the discussion of two common aspects for those unfamiliar with qualitative research, aimed at comprehending its delineation compared to quantitative methods. This is pertinent especially when the adopted methodological reference, such as Krippendorff's Content Analysis,(¹,²) can be applied to both qualitative and quantitative approaches. Even within the qualitative approach, this can be achieved through categorical or thematic analysis, with the latter being the model utilized in this study.

While this method is less commonly used in Brazil, it is a well-established and rigorously validated approach in Europe and the U.S., ensuring both truth-worthiness and reliability in our findings. We applied systematic thematic analysis in strict adherence to Krippendorff's framework, a process that prioritizes methodological transparency and minimizes bias. The resulting thematic patterns, shown in the dendrograms (pages 4–6), were created from a structured, iterative analytical process, further reinforcing the study's truth-worthiness by demonstrating clear, reproducible patterns in the data. It is important to emphasize that a representative sample, with the aim of achieving generalizable results, is a fundamental characteristic of quantitative research.

Qualitative studies that adopt Krippendorff's Content Analysis seek to understand the meanings of the symbols of a given phenomenon within the context in which it was produced and are not subject to generalization. The aim was to understand the experiences of postpartum women hospitalized in the rooming-in unit during pregnancy, examining them from their perspective and considering the context of the pandemic and not the disease itself or its impacts.

Not that it involves demonstration, studies of a qualitative nature adopt non-probabilistic demonstration outlines, such as, for example, demonstration by convenience used in the present study, being endorsed by means of its adequacy and appropriation.

The final sample is generally small and usually defined over the length of the study to guarantee the satisfaction and depth of the information perceived. Theoretical saturation, provided by this study, occurs when even new data does not reveal new information and the redundancy was reached. As presented in our article, even though the saturation of the data has been determined before the analysis of the 106 interviews, we opted for the analysis of all material, ensuring methodological rigor.

The thematic representation, described in a hierarchical manner, demonstrating the construction of reasoning by researchers and adhering to Krippendorff's proposed methodology, was presented in manuscript by means of four tree diagrams called dendrograms on pages 4-6.

We are available to assist with any questions regarding the drafting of a qualitative study and are ready to clarify any remaining doubts.

References

• ¹ Krippendorff K. Content analysis: an introduction to its methodology. 4th ed. Thousand Oaks: Sage; 2019.
• ² Rossi GB, Serralvo FA, Joao BN. Análise de conteúdo. ReMark Rev Bras Mark. 2014;13(4):39-48. doi: 10.5585/remark.v13i4.2701
  » https://doi.org/10.5585/remark.v13i4.2701

Publication Dates

• Publication in this collection
  04 Aug 2025
• Date of issue
  2025

History

• Received
  21 Apr 2025
• Accepted
  30 Apr 2025