PONE-D-20-26756

Adverse Birth Outcomes and Associated Factors among Diabetic Pregnant Women in Ethiopia; Systematic review and Meta-analysis

PLOS ONE

Dear Dr. Belay,

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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

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

Reviewer #1: Yes

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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

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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: No

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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 would like to congratulate the authors to address such a good topic to discussion. It is so important to bring to light the information about diabetes, which is an underestimated and poor screened disease during pregnancy. It is a condition which is relatively cheap to be detected and when in the majority of the cases have a good control with conservative approach but the implications of not address it is importance could affect negatively mother and children.

All my comments are in order to improve the quality of the paper for the reader.

Tittle

The title is appropriate and brings curiosity for the reader to continue reading.

Abstract

The abstract is appropriate, however, if you agree to change the points of the text, this must also be readjusted in the abstract.

Introduction session

#1 The first paragraph of the introduction is a little bit complicated to understand, I suggest a major review of the English and rewrite it for better read.

#2 In the second paragraph: what do you mean with “pre-gestational DM”, it is a little confuse with the previous information of the first paragraph, please rephrase it to a single paragraph for further clarification. In addition I suggest add a reference to “Gestational DM affect 2-3% of pregnancy and pre-gestational DM affect 0.2-0.3% of pregnancy is the most common metabolic abnormalities of pregnancy which result in different adverse birth outcomes both for the mothers and neonates.”

#3 I also recommend to replace the term diabetic mother to a women with hyperglycaemic pregnancy.

#4 During all introduction section you referred to DM 1 and 2 and GDM, but your target is the hyperglycaemic pregnancies, so I think that is interesting bring some data separately in the first paragraph but in the others make sense to refer to this pregnancy condition as hyperglycemic disturbs (or any other similar expression).

# 5 In third paragraph the authors bring some interesting informations but I recommend rephrase it and use story telling technique to clarify and connect all the informations and paragraphs. In addition I suggest to delete the phrase “which is important for policy maker to set preventive strategies.” in the end of the introduction and add it to discussion section.

Methods session

# 6 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.

# 7 It is nuclear about the publication years of the articles selected, language, publication status

#8 I would like to recommend you to change the expression “poor quality” for the reason, I mean, which was the problem to not include it? Study design? Sample size? Not clear outcomes?

# 9 In phrase “the prospective follow up study reporting the prevalence of adverse birth outcomes or and a minimum of one contributing factors for adverse birth outcomes conducted in Ethiopia were included”. Did you establish a minimum and maximal follow up period? Let this information clear.

# 10 Please replace still births to stillbirths

# 11 Please replace soft wear to software in the phrase “The extracted data were transferred to STATA version 14 statistical soft wear for meta-analysis”

Results session

#12 In the first paragraph “Three hundred seventy seven articles were retrieved using a search strategy from PubMed, Cochrane Library, Google Scholar, SCOPUS, Web of Science and PsycINFO”, you didn’t mentioned the Addis Ababa and Haramaya University online repository.

# 13 I highly recommend to add the references into the tables to allow the reader find the articles easier.

#14 Table 4 was included Maternal age <35 years but in the text in socio-demographic factors session “Addis Ababa indicated that the odds of having adverse birth outcomes among diabetics women age less than 30 years old was 3.47” please clarify this point for us.

#15 Your results bring more than the purposed by the aim of your paper. “Therefore, this systematic review and meta-analysis is the first aimed to estimate the pooled prevalence of

adverse birth outcomes and associated factors among diabetic pregnant women in Ethiopia which is important for policy maker to set preventive strategies.” You actually brings the prevalence, pregnancy related risk factors and the adverse birth outcomes and during your data presentation in table 1, I expected that the pregnancy related risk factors should be present on it.

#16 Another concern is about the measure units in the table, please review it. I suggest to fix two decimal cases as standard to the table values.

Discussion Session

# 17 In order to improve the discussion I highly recommend the use of storytelling techniques to help you to delineate the findings and discuss it with the already included data. In the first phrase is interesting to add the mainly findings in an easy and quickly summarization to the reader follow the discussion topics of each findings and its possible explanation.

#18 It is of paramount importance to perform a major English revision

Conclusion Session

#19 The conclusion should address the aim.

AIM: “To estimate the pooled prevalence of adverse birth outcomes and associated factors among diabetic pregnant women in Ethiopia which is important for policy maker to set preventive strategies.”

Conclusion: “According to this systematic review and meta-analysis, the pooled prevalence of adverse birth outcome among diabetic women in Ethiopia was high. Unable to read and write, maternal age less than 30 years old, gestational age less than 37 completed weeks, previous adverse birth outcomes and no ANC follow up was significantly associated with adverse birth outcomes.”

I would like to rephrase the conclusion to further clarification. The phrase “Ethiopia was high” comparing to????. I suggest to replace by the %.

In addition, again I will insist that your data brings not only the prevalence of adverse birth outcomes, pregnancy related risk factors, but the adverse birth outcomes, and it should be addressed in the conclusion and in the aim.

Thank´s.

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Reviewer #1: No

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Adverse Birth Outcome and associated factors among Diabetic Pregnant Women in Ethiopia; Systematic review and Meta-analysis

PONE-D-20-26756R1

Dear Dr. Belay,

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,

Frank T. Spradley

Academic Editor

PLOS ONE

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

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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

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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: The paper is appropriate and has been revised according to the reviewer's suggestions. The results are relevant and will contribute to the dissemination of knowledge in this important area of health.

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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: No