PONE-D-25-16415Assessing the burden of severe nausea and vomiting of pregnancy or hyperemesis gravidarum and the associated use and experiences of medication treatments: an Australian consumer surveyPLOS ONE

Dear Dr. Grzeskowiak,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 18 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Shipra Sonkusare, MD, DNB, MNAMS, FICOG, MRCOG, FRCOG

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf .

2. Thank you for stating in your Funding Statement:

“This study was supported by a 2020 Engaging Opportunities research grant provided by the Robinson Research Institute, The University of Adelaide. LEG receives salary support from the Channel 7 Children’s Research Foundation (CRF-210323). The funding source(s) had no involvement in the conduct of the research and/or preparation of the article.”

Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now.  Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement.

Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf.

3. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

Before we proceed with your manuscript, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible.

Please update your Data Availability statement in the submission form accordingly.             

4. Thank you for stating the following in the Acknowledgments Section of your manuscript:

“This study was supported by a 2020 Engaging Opportunities research grant provided by the Robinson Research Institute, The University of Adelaide. LEG receives salary support from the Channel 7 Children’s Research Foundation (CRF-210323). The funding source(s) had no involvement in the conduct of the research and/or preparation of the article.”

We note that you have provided additional information within the Acknowledgements Section that is not currently declared in your Funding Statement. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

“This study was supported by a 2020 Engaging Opportunities research grant provided by the Robinson Research Institute, The University of Adelaide. LEG receives salary support from the Channel 7 Children’s Research Foundation (CRF-210323). The funding source(s) had no involvement in the conduct of the research and/or preparation of the article.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

5. We note that you have included the phrase “data not shown” in your manuscript. Unfortunately, this does not meet our data sharing requirements. PLOS does not permit references to inaccessible data. We require that authors provide all relevant data within the paper, Supporting Information files, or in an acceptable, public repository. Please add a citation to support this phrase or upload the data that corresponds with these findings to a stable repository (such as Figshare or Dryad) and provide and URLs, DOIs, or accession numbers that may be used to access these data. Or, if the data are not a core part of the research being presented in your study, we ask that you remove the phrase that refers to these data.

6. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section.

7. Please remove your figures from within your manuscript file, leaving only the individual TIFF/EPS image files, uploaded separately. These will be automatically included in the reviewers’ PDF.

[Note: HTML markup is below. Please do not edit.]

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: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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: No

Reviewer #2: Yes

**********

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

**********

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: This is an insightful study that provides valuable new perspectives on the management of nausea and vomiting during pregnancy.

The abstract effectively summarizes the main concepts and objectives of the study.

The introduction provides a comprehensive background and clearly outlines the objective of the research.

However, the methodology section raises a few points that require clarification:

1. Could the authors specify how the responders were selected for the study?

2. Please provide further details regarding the validity and reliability of the questionnaire used.

3. When were the responders approached to complete the questionnaire? Was it during their pregnancy? If so, at which trimester?

The results are presented in a clear and organized manner.

The discussion is thorough and adequately addresses the key findings of the study.

Reviewer #2: The authors reported results about an online, national survey of 289 Australian women who were currently or had previously experienced severe NVP or HG, distributed through the HG consumer group, Hyperemesis Australia between July and September 2020. They showed a large variability in antiemetic use and outcomes, highlighting the need for individualized care and treatment approaches during pregnancy.

The subject is interesting because very few published data reported results about national survey in women with NVP or HG. Nevertheless, the study contains many flaws/bias that decrease the interest for the study and major modifications should be done for more clarity.

First, a BIG bias: the survey was realized in women with severe NVP or HG through the HG consumer group, Hyperemesis Australia. Some affirmations were quite evident: “More than 50% of respondents reported major impacts...”, and some affirmations should be written with caution and more discussed: “54% reporting considering terminating their pregnancy and 90% having considered having no more children”. Nevertheless, only 59% of included women were classified as severe NVP using the PUQE score. So, who are the included women????? Are the conclusions adapted???

Second, the recruitment method induced another bias in results such as treatments used in fist line (91% ondansetron and 95% in first trimester) because only severe NVP or HG were included. Many of included women had also experienced HG in a previous pregnancy with ondansetron (64%) as a second or a third line treatment in this previous pregnancy and was then directly used ondansetron as first line in a new pregnancy with HG. It is quite logical!

The authors should clarify who were the included women: severe NPV or HG, only HG, all women with NVP..). In abstract, in the conclusion, “in cases of severe NVP or HG” should be added to recontextualize. In methods, in “study design”, it is written: “Women currently living in Australia and who were currently or had previously experienced HG were eligible to complete the survey”. Severe NVP as an inclusion criterion has been deleted!

The discussion is too long, should be shortened, and bias should be more discussed.

**********

6. 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

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Assessing the burden of severe nausea and vomiting of pregnancy or hyperemesis gravidarum and the associated use and experiences of medication treatments: an Australian consumer survey

PONE-D-25-16415R1

Dear Dr. Grzeskowiak,

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.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Shipra Sonkusare, MD, DNB, MNAMS, FICOG, MRCOG, FRCOG

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: