PONE-D-24-38352Effects of Maternal Anemia on low-birth-weight in Sub-Sahara African countries: systematic review and meta-analysisPLOS ONE

Dear Dr. Belete,

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-Prognostic role of vitamin D receptor in breast cancer: a systematic review and meta-analysis (DOI: 10.1186/s12885-020-07559-w)

Perinatal outcomes in anemic pregnant women in public hospitals of eastern Ethiopia (https://doi.org/10.1093/inthealth/ihac021)

(Among others)

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Partly

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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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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: question 4 comment: Requires careful editing for proper English grammar

The sizable impact of low birth weight in neonates and its link to mortality and morbidity has long been known.

Many published papers, but certainly not all, have reported associated between iron deficiency anemia in pregnancy and low birth weight. It is difficult for a reader to determine if the meta-analysis and systematic review was focused on anemia or on iron deficiency anemia.

The authors correctly point to the importance of adequate nutrition as a preventive measure to reduce low birth weight.

Rates of iron indices in pregnancy vary greatly among African countries. These rates are impacted by factors such as iron in groundwater, a deficiency in related micronutrients, the presence of helminths, HIV/AIDS, body weight, age, prior pregnancy history, and perhaps most importantly the hemoglobin level (and ferritin) present when a woman enters pregnancy.

Of the 21 studies reviewed, it is important to note that none were randomized, placebo-controlled trials. While the association of anemia to lower birth weight in anemic women during pregnancy appears to be confirmed, it is difficult to extrapolate the importance of these findings on actionable approaches to care.

While the standards for a systematic review and metanalysis are well maintained, the reported findings may not be generalizable.

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Reviewer #1: No

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Effects of Maternal Anemia on low-birth-weight in Sub-Sahara African countries: systematic review and meta-analysis

PONE-D-24-38352R1

Dear Dr. Belete,

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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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

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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

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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 #1: This meta-analysis confirms that anemia in pregnancy is associated with low birth weight in selected areas of sub-Saharan Africa. The inclusion of 21 articles lends strength to this conclusion.

The authors have adequately addressed the reviewers concerns and the paper is now publishable.

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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

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