Thanks for your interest in our study! This was a large-scale study of over 4,000 women, and long interviews + home visits would have required additional resources. Self-reported measurements are also more prone to biases and error. Invasive testing (combined with prior maternal risk factors) can be predictive of adverse pregnancy outcomes, as shown for example in our recently published paper: http://hyper.ahajournals.org/content/early/2017/02/06/HYPERTENSIONAHA.116.08620.

 Thanks for writing back.   I would love to agree with you but then we would both be wrong.  Long interviews would have required more time and care, but not additional resources.   Your tests are equally prone to error as self reported diet and exercise.  And once you make a home visit, then there is no error.  You see exactly what the woman is eating. Ultimately, if home visits did require more money,  which it wouldnt and  doesnt, at least it would result in improved outcomes.    Your work does not result in improved outcomes.   Where the woman is defined to have a risk of preeclampsia,  what have you achieved?  Besides, Just take her blood pressure and you know whether she is at risk of preeclampsia.

 Your testing just results in more women being defined as high risk, and sometimes that results in worse outcomes. Your testing has a degree of false positives.  False positives cause actual damage in terms of worry and distress and the occasional death (1 in 5000) from unnecessary cesareans and the 1 in 15,000 death from amniotic fluid embolism caused by  inductions, not to mention that the woman loses confidence in her body for the rest of her life.   Whereas improving diet and life style changes always improves outcomes.  

 Even though I am 61 years old,  i am still shocked at the participation of women like yourself in the movement to define women as high risk and force them to undergo testing that is used for the sole purpose of defining them as potentiall high risk, that will not improve the pregnancy outcome when it is compared to nutrition and life style counseling and support and never does it give the woman a feeling of confidence in her abilty to birth and thereby mother.

"Your tests are equally prone to error as self reported diet and exercise."

Please elaborate; how can scientific testing done correctly be equal to self-reporting?

"And once you make a home visit, then there is no error."

A home visit is no guarantee of truthfulness, obviously one cannot watch them every day!

I spent decades investigating couple with recurrent miscarriages or "unexplained " infertility. I took  dietary histories which was not difficult because most ate cereals for breakfast, sandwiches for lunch and pasta meals for dinner plus wine.  90% were zinc deficient  ( WBC) and  80% were magnesium deficient ( RBC)  and often copper, selenium, chromium, B vitamin and  PUFA pathway deficient. Having the biochemical test results from Biolab London  was a great help because couples were then keen to eat  low allergy, high protein diets and take tailored supplements. The aim was to have normal range test results for a least 3 months before conception to encourage normal spermatogenesis and allow healthy pregnancies even in couples who had a history of failed IVF attempts.

I suggest to start with a test more easily than the two questioned as it can be an effective clinical and nutritional risk screening to monitor these risks throughout the observation period? Thus we can watch the possible deviations that may occur in the physiological balance of the internal environment (homeostasis) of the mother

QUESTION "Your tests are equally prone to error as self reported diet and exercise."  How can scientific testing done correctly be equal to self-reporting?  ANSWER: Scientific testing produces false positives and false negatives, which cause more testing.  I believe that tests for prostate cancer in men have been stopped because they resulted in more damage than good.  This is true in the testing for preeclampsia but when it comes to women there is not the fear of doing damage as we see in the sky high rates of cesarean and induction, which do kill women. In interviews with doctors, most people do tend to tell some truths when they visit the doctor and the problem is not false positives, but the doctor being skilled enough or interested enough to ask them the right questions.  For example, instead of asking do you smoke, one can ask, how many cigarettes do you smoke per 24 hours?  Look for signs of smoking.   One can insist on a three day diet diary.

QUESTION "And once you make a home visit, then there is no error." A home visit is no guarantee of truthfulness, obviously one cannot watch them every day! ANSWER: I would guess that you are not familiar with home visits.  At home visits, you see exactly what is going on if you pay attention.  Just open the refrigerator and the food cabinets and go to the bathroom.  If one is interested, there is very little one can hide at a properly conducted home visit.  People are not going to go stock up on tons of foods that they never eat.

I dont know how the conversation got changed from tests for preeclampsia to infertility, but infertility is of course very related to diet and life style and whether the couple are copulating.

 Thanks for your questions.