PONE-D-24-38857Maternal occupation and risk of adverse fetal outcomes in Tanzania: a Hospital- based cross-sectional studyPLOS ONE

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Reviewers' comments:

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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: Yes

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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

Reviewer #2: Yes

Reviewer #3: 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: In the abstract, the necessity of the research is not clearly stated.

At the end of the conclusion, make suggestions for future studies.

State the strengths of your study at the end of the discussion.

Reviewer #2: Thank you for this study.

It is a good addition to support the impact of agricultural chemicals on the fetal outcomes.

The study was well written, and data were adequate enough to support the conclusion of your study.

Please find below my comments:

Line 20: Consider replacing the phrase with "reproductive health"

Line 66-68: Reference please

Line 81-83: This sentence seems to break the good flow of your social argument of the study.

I do not think it is necessary.

Rather elaborate on the strength of the contradictory findings. Thanks

Line 83: I think it is worth mentioning that the women in labor force is actually highest in the sub-saharan African compared to any other regions globally.

Line 84: You mean " pregnancy"?

Line 93: This is a good description of the study setting.

Thank you.

Line 118- 119: Can you explain why this was considered a good criterion when some studies actually support the increase incidence of preterm delivery in multigravida women exposed to frequent excessive occupational pressures?

Line 118-120: is preeclampsia or Gestational DM exclusion? if so why/

Why is HIV considered an exclusion?

Line 136- 137: Very important denominator in defining the risk associated with the undesirable outcomes if any.

Line 184: I think the obstetric high risk age groups are supposed to be independently categorized... < 17 and >35.

The outcome variables in these group may not strictly be due to the occupational exposures

Consider an adjustment in this regard.

Line 209: I think your discussion of the data above were too precise with little or no diversification from the previous studies.

This will affect both the social and scientific value of the study.

I will suggest you go through the data again and identify some more unique characteristic of this study compared to similar studies over the world.

Thanks.

Line 217- 219: This finding is in line with the data in your study, however, I am expecting that your discussion will acknowledge the following:

1. Farming and Agriculture still remains the commonest occupation in sub–Saharan Africa.

2. Farming and Agriculture in Tanzania may not be as mechanized as in the California where the quoted research was conducted.

please consider how these two factors could affect the validity of your study outcomes

Line 250-254: I think there are more limitations to this study.

It is well researched but the limitations are so many e.g. Most women in sub saharan African are actually multitasking to keep their home .. most of the people documented as working in agriculture sector could still be street food vendors. This study didn't assess the cumulative effect of this.

Please identify others.

Good luck

Reviewer #3: The topic and objective of this study address one of the most pressing health issues in developing and underdeveloped societies. Its findings could provide a basis for improving women’s employment conditions, labor laws, and occupational and environmental health policies. Enhancing the methodology, resolving ambiguities, and expanding the discussion would further strengthen the study's impact. Additionally, the text requires grammatical corrections and linguistic refinement to improve its overall clarity and quality.

Comments:

Line 117: Purposive sampling, while useful for targeted populations, limits the generalizability of the findings due to potential selection bias. Random sampling would have provided stronger external validity.

Line 117: While an 80% response rate is reasonable, it still leaves room for non-response bias. The study does not discuss characteristics of non-respondents, which could help assess this bias. Analyze demographic and clinical characteristics of non-respondents to understand potential biases in the data.

Line 118: Collecting data exclusively within 72 hours of delivery may exclude women who give birth outside healthcare facilities, potentially introducing systematic bias by underrepresenting specific populations, such as those in rural or underserved areas. Expanding the data collection timeframe and including a wider range of delivery settings, such as home births, could help ensure a more representative sample.

Line 120: What criteria were used to diagnose heart disease, kidney disease, sickle cell anemia, and HIV? Were these conditions assessed using a standardized method consistently applied to all study participants by the researchers during data collection, or were they documented based on previous medical records with varying approaches? Clarification is needed.

Line 127: Occupational histories and physical demands rely on maternal recall, which could be subject to recall bias, especially in a retrospective framework. Supplement self-reported occupational data with workplace inspections or supervisor verification to reduce recall bias

Line 140: The study assesses adverse outcomes only immediately after delivery, missing longer-term neonatal or maternal health impacts.

Line 143: Although the questionnaire was translated into Swahili, nuances in occupational terms or descriptions may not have been perfectly captured, potentially impacting the accuracy of the exposure data.

Line 211: "The commonest type of occupation was agriculture, tailoring and hairdressers." should use plural verb agreement

Line 214: "The type of occupation positively associated with the largest number of adverse fetal outcome was agriculture." Correct usage: "outcomes were agriculture."

Line 216: "The higher odds of adverse fetal outcomes among agricultural female workers is related to pesticide exposure." Correct usage: "are related to pesticide exposure."

Line 249: Provide a brief discussion of possible interventions (e.g., protective measures or policy recommendations) to mitigate occupational exposures for pregnant women.

Line 250: The limitation section is underdeveloped. Include details on how biases (e.g., recall, reporting) and confounding variables (e.g., socioeconomic factors) might have affected results.

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Reviewer #1: No

Reviewer #2: Yes:  Prof. Adeloye Amoo Adeniji (MBBS; MMed; FCFP; FACRRM).

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Occupation and fetal outcome.pdf

Maternal occupation and risk of adverse fetal outcomes in Tanzania: a Hospital- based cross-sectional study

PONE-D-24-38857R1

Dear Dr. Baldwina,

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.

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Kind regards,

Kahsu Gebrekidan, Ph.D.

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

Reviewer #3: 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

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #3: 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

Reviewer #3: 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 #2: Dear Author,

Thank you for appropriately addressing my concerns raised in the previous review of this article.

I think the study is now suitable for publication.

The conduct of the study agrees with the minimum standard required of a cross-sectional study.

The results are well presented intelligently.

Your discussions should provoke scientific arguments in among scholars.

Thank you for adding to the body of knowledge on maternal occupations and fetal outcomes.

Congratulations.

Reviewer #3: (No Response)

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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:  Adeloye Amoo Adeniji (MBBS; MMED; FCFP; FACRRM)

Reviewer #3: No

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