PONE-D-20-17353

Pre-Pregnancy Maternal BMI As Predictor Of Neonatal Birth Weight

PLOS ONE

Dear Dr. Gul,

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.

This manuscript has divided opinion amongst the reviewers. I believe that the study is not without interest but it is currently in need of a major revision before it could be considered for publication.

Even before considering the reviewers' comments, It is obvious that the manuscript requires major improvement in the quality of English language used. I would therefore suggest that the authors enlist the assistance of a native English speaker to help with this. I think that of the various reviewers' comments the most important to consider is that much of the study does not seem to relate directly to its stated aim. The paper needs to be written in such a way that it develops from its aim.  In addition, it is key to present the direct association between maternal BMI (as a continuous variable) and neonatal weight (also as a continuous variable) in any revision. Finally claims of "significance" need to be removed where p>=0.05 or the 95% confidence intervals cross either side of 1.00.

All the other points raised by the reviewers need to be dealt with robustly in any revision, but the above points are of particular importance when considering whether or not any revisions can accepted for publication.

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Clive J Petry, PhD

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: Partly

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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: Yes

Reviewer #2: Yes

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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

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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: I want to congratulate the authors for the effort in writing this interesting paper. Overall, I think the paper needs to improve the grammar and the fluency of the reading specially in the introduction section. I have other minor comments as well.

Introduction

- I'm not sure if maternal BMI measures body fat; instead, it is a ratio between weight and height, can you please include the reference of this sentence?

- It would be interesting to know the consequences of pre-pregnancy BMI on the offspring health

- Authors mention "fetal programming" but I would be interesting to know the conection between programming and pre-pregnancy BMI, at least in general.

- I'm not sure if the last sentence of the introduction section is related with the aim of the study, e.g. the study evaluates preventive measures?

Materials and methods

- Why authors did not consider materna weight gain during pregnancy as a newborn weight factor?

- I consider it is important to know the method to take the maternal measures as weight and height as well as the method to take the newborn weight.

- Why the authors did not include newborn height, not even as a characterisation variable?

- Medical records are electronic, hand writing, etc?

- How did the authors verifies the quality of data?

Results

- I don't understand the associations in table 1, I consider it need some legend at the end to clarify the comparisons between significant associations.

- City and village mean urbal and rural?

- As the main outcome is the birth weight, tables do not reflect that association. It seems like authors made associations with maternal BMI as the main outcome.

- I strongly recommend the authors to show the association between maternal BMI and birth weight, as it is the aim of the study.

Discussion

- It should be mainly about the association between birth weight and maternal BMI and not about the factors that affect maternal BMI

Reviewer #2: The results are not consistent with the purpose of the study. (Relation between pre-pregnancy BMI and neonatal birth weight, whereas majority of results concern on anemia, hypertension and diabetes mellitus).

Result are not statistically significant in many cases although authors state that they are.

In methods study is descripted as prospective, descriptive. In discussion study is descripted as retrospective, cross-sectional. It should be unified.

There is lack of information about excluded cases.

Table 1 show only that there is a lot of confounding factors, there is no possibility to form conclusion on it. There is lack of post-hoc tests. Authors made 2 categorizes of overweight and obese but then reported in as a one group >25kg/m2.

Table 2 is unclear. It related to risk factor of what in pregnancy? I can guess that it is risk factor of hypotrophy or macrosomia but I'm not sure. It should be explained what mean medical illnesses, uterine problems. I don't know why singleton pregnancy is a risk factor. According to WHO appropriate gestational weight gain is different for underweight, normal weight, overweight and obese. So 10-15 kg is not correct value.

The most important calculation which concern BMI and birth weight should be in table, no in graph without any statistics, not only in text. Also raw date about newborns length and occipital frontal circumferences give us no information.

In introduction there is a lot about malnutrition, but then authors conclude that in Pakistan there is much higher problem with overweight and obese, may be introduction should be rewritten.

Discussion is unclear, hard to read, not interesting.

There is lack of unit in BMI

There is lack of abbreviation explanation (SVD, LSCS, OFC)

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Reviewer #1: Yes: Fanny Aldana-Parra

Reviewer #2: No

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Pre-Pregnancy Maternal BMI As Predictor Of Neonatal Birth Weight

PONE-D-20-17353R1

Dear Dr. Gul,

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.

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Kind regards,

Clive J Petry, PhD

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

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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: Yes

**********

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: I consider the authors addressed the majority of my comments and the comments made by other reviewers, I consider that the paper can be published.

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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: Yes: Fanny Aldana-Parra