PONE-D-24-25079The impact of perinatal maternal stress on the maternal and infant gut and human milk microbiomes: A scoping reviewPLOS ONE

Dear Dr. Ryan,

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Jayakrishna Madabushi, MD

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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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

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've read through the manuscript, and I find it to be technically sound, with the data presented largely supporting the conclusions drawn. The scoping review method you've chosen is well-suited to the research question, and it's clear that you've adhered to established guidelines, such as the Joanna Briggs Institute’s methodology and PRISMA-ScR reporting standards.

The statistical analyses seem to be handled appropriately, and the rigor is evident. That said, I did notice some significant heterogeneity among the included studies, which could impact the generalizability of your findings. It might be helpful to delve a bit deeper into how this heterogeneity could influence the overall conclusions.

I think the discussion could benefit from a bit more depth, particularly when it comes to the methodological challenges and inconsistencies across the studies. Addressing these issues more thoroughly could provide readers with a better understanding of the current state of research in this area and offer clearer guidance for future studies.

Reviewer #2: Thank you for the opportunity to review this manuscript. The study does a great job exploring how perinatal maternal stress affects the maternal and infant gut and human milk microbiomes. The manuscript is clear and well-organized. However, there are a few areas where adding more detail and clarity could further strengthen the overall study.

Introduction: Consider addressing the impact of maternal nutrition on maternal and infant microbiomes during the perinatal period. Maternal diet is a critical factor that can influence the composition and function of the microbiome, potentially affecting maternal health, pregnancy outcomes, and infant development.

Methods : Please include a discussion on the quality assessment of the included studies.

Consider addressing potential biases such as selection bias, publication bias, and reporting bias, and their possible influence on the review’s results.

Results and discussion : Explain how the findings might be applied in clinical settings. Consider how the findings of your review might influence guidelines for prenatal care, particularly regarding stress management

Indicate whether a sensitivity analysis was considered or conducted to evaluate the robustness of the findings.

Consider addressing the variability in how studies define types of stress (e.g., psychological vs. physical, acute vs. chronic) and the tools used to measure stress (e.g., self-reports, physiological measures).

Discuss the potential confounding effects of comorbid conditions (e.g., depression, anxiety, or physical health issues) that could influence both maternal stress and microbiome composition.

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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

Reviewer #2: Yes:  Mohsin Raza

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The impact of perinatal maternal stress on the maternal and infant gut and human milk microbiomes: A scoping review

PONE-D-24-25079R1

Dear Dr. Ryan,

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,

Juan J Loor

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 #2: 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 #2: Yes

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

Reviewer #2: N/A

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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 #2: 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 #2: Yes

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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 #2: Please elaborate on which dietary factors or specific nutrients are shown to influence the maternal and infant microbiome.

Everything else has been addressed adequately.

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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 #2: Yes:  Mohsin Raza

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