PONE-D-24-44685The maternal postnatal six-week check in women with epilepsy: does the prevalence or subsequent postpartum health differ from the general postnatal population?PLOS ONE

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Reviewer #1: Yes

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

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1:  These researchers sought to determine if there is a difference in attendance at a six-week postpartum check among patients with and without epilespsy. Further if patients attended a SWC, were there differences in mental health outcomes or epilepsy-related complications. They used 4 administrative databases/registries to evaluate this question. Specific codelists were previously used to identify this population and healthcare visits. The statistical analysis seems appropriate using Poisson regression modeling as the outcome of a SWC if very common. Several models were fit to evaluate for possible important associations. Importantly, appropriate confounders were selected based on either prior evidence or hypotheses for confounding effects. Patients identified as having epilepsy were relatively similar to those without, apart from number of prior health care visits prior to pregnancy, and index of multiple deprivation.

Overall, the researchers used rigorous methodology to answer challenging but meaningful questions.

SPECIFIC POINTS:

INTROUDCTION:

Line 128 - Describe term A&E

METHODS:

Line 150 - Describe "Stillbirth" and how this is captured differently than miscarriage/clinical pregnancy loss

RESULTS:

Line 265-266 - the median age between the two groups is nearly identical. Similarly, prior prescription of prophylactic or emergency contraception, urinary/faecal incontinence and dyspareunia/pelvic pain are very similar between the groups. I assume these differences stated are based on a statistically significant p-value (which is not reported), and largely because of the large sample size rather than clinically meaningful differences between the groups.

DISCUSSION:

Line 511 - I think you need to consider more strongly that GPs may not be assessing symptoms of dyspareunia and other symptoms of pelvic floor dysfunction adequately. This may be a reflection of a patient's discomfort with their GP, which is why they are not attending the SWC and therefore have a lower reported incidence. Alternatively, it is a poorly coded variable. Have there been any validation studies of the codes you are using to identify these symptoms with accuracy? I suspect these results are largely underrepresented in the way these data are collected.

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Reviewer #1: No

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The maternal postnatal six-week check in women with epilepsy: does the prevalence or subsequent postpartum health differ from the general postnatal population?

PONE-D-24-44685R1

Dear Dr. Fitzpatrick,

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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