-->PONE-D-25-01416-->-->Sickle cell disease and maternity care: A qualitative synthesis of women’s and health providers experiences.-->-->PLOS ONE

Dear Dr. Finlayson,

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 Apr 02 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'.
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-->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,

Katibe Tugce Temur

Academic Editor

PLOS ONE

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

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3. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following:

A numbered table of all studies identified in the literature search, including those that were excluded from the analyses.

For every excluded study, the table should list the reason(s) for exclusion.

If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed.

A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study:

Name of data extractors and date of data extraction

Confirmation that the study was eligible to be included in the review.

All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses.

If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group.

If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome.  Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome.

An explanation of how missing data were handled.

This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected.

4. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match.

When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

5. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Author,

Thank you for submitting your manuscript for evaluation. However, in order to strengthen and clarify your manuscript, the following revisions are recommended:

Introduction Section:

You should clearly emphasize the necessity of your study and explicitly address the research gap to make the introduction more focused.

Methods Section:

Inclusion and exclusion criteria should be described in more detail. This is crucial for ensuring the reproducibility of the study.

Discussion Section:

The discussion should be concise, and redundant points should be removed.

Most of the included studies originate from the United Kingdom and Brazil. This may limit the generalizability of the findings to other regions, particularly to low-income countries (LICs), where SCD is more prevalent. This limitation should be explicitly acknowledged, and the potential variations in findings across different contexts should be discussed.

Only three studies focusing on healthcare providers are included, all of which are from the United Kingdom. This limits the understanding of healthcare providers' experiences in different healthcare systems. This limitation should be addressed, and future research directions should be proposed.

The discussion should conclude with recommendations for future studies.

Abbreviations Table:

To enhance readability, please provide a table listing the abbreviations used in the manuscript.

Limitations Section:

A separate section should be added to discuss the limitations of the study in greater detail.

References:

Since most of the references are older than five years, it is recommended to update some of them with more recent literature.

Additionally, we encourage you to review your manuscript for compliance with PLOS ONE formatting and writing guidelines. A general revision regarding language and clarity would also be beneficial. Please submit a revised version with the implemented changes clearly indicated.

Best regards,

Editor

[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: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: N/A

**********

-->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: Dear Author

Thank you for submitting your article for review

Your study is very valuable

The following comments are provided to improve the research:

In the introduction section, the necessity of the work should be clearly stated

In the methods section, the inclusion and exclusion criteria of the study should be more precisely stated.

The discussion should be strengthened.

At the end of the discussion, suggestions for future studies should be mentioned.

Thank you

Reviewer #2: Thank you for your qualitative paper on: Sickle Cell Disease and Maternity Care: A Qualitative Synthesis of Women’s and Health Providers’ Experiences

Please find my comments

1- Introduction could be focused, addressing the research gap as well.

2- Discussion needs to be concise, some points are repeated .

3- The majority of the included studies are from the UK and Brazil, which limits the transferability of the findings to other regions, particularly low-income countries (LICs) where SCD is highly prevalent. The authors should acknowledge this limitation more explicitly and discuss how the findings might differ in other contexts.

4- The manuscript includes only three studies focusing on healthcare providers, all from the UK. This limits the understanding of provider experiences in different healthcare systems. The authors should discuss this limitation and suggest areas for future research.

5- Please provide a table for abbreviations.

6- Please provide a section for limitations.

7- Please update some of your references, as most of your references are more than 5 years outdated.

**********

-->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.-->

-->PONE-D-25-01416R1-->-->Sickle cell disease and maternity care: A qualitative synthesis of women’s and health providers experiences.-->-->PLOS ONE

Dear Dr. Finlayson,

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.-->--> -->-->Kindly the comments of the reviewers are well addressed. -->-->

Please submit your revised manuscript by Oct 17 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,

Abiola O. Olaleye, MBBS, MPH, FWACP

Academic Editor

PLOS ONE

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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

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

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

**********

-->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: No

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: N/A

**********

-->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: No

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->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: No

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 #1:  (No Response)

Reviewer #2: Thank you for addressing the previous reviewers' comments. I would say that I don't have any concern accepting this work for publication.

Reviewer #3: I note that the manuscript has already undergone a round of reviews and revisions have been submitted by the authors in response to these. I have been invited to assess the manuscript as a new reviewer, but have considered previous comments and responses in doing so. My additional comments are:

1. The entire manuscript would benefit from editing for syntax as some of the sentences are very long and unwieldy (e.g., the entire Methods section of the abstract is one sentence). In other places, the sentences read repetitive of already provided content. A good proofread for ‘polishing’ and tightening up the text would make for a better flow of text.

2. Why is the PRISMA reporting guideline being used when this is a qualitative evidence synthesis. A more appropriate reporting checklist is ENTREQ (Enhancing transparency in reporting the synthesis of qualitative research). Unless the Journal specifically requests PRISMA is used, then I suggest ENTREQ is used instead

https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-12-181

3. Box 1 is not actually a Box, it is a Table (i.e., 2 columns and 2 rows; a Box is simply that with no internal dividers). This should be relabelled as Table 1 and other Table numbers adjusted accordingly.

4. The list of abbreviations appears incomplete, e.g., CNKI (China National Knowledge Infrastructure), MIDIRS (Maternity and Infant Care database), etc., should be included in the list

5. Where you say ‘20% of abstracts were screened in duplicate to ensure consistency between the reviewers’ what was the outcome of this, i.e., what was the % agreement on these 20%. Also, this appears to contradict with the previous sentence, where it notes two reviewers independently assessed abstracts – do you mean, the 20% were screened as a consistency check, and then both reviewers continued with the remainder. Better clarity is required

6. Similarly in quality appraisal, you note a 20% sample were cross-checked, but if both reviewers independently did this, why were all not checked or what was the outcome of the 20% check, and what happened as a result, especially as you then note, a third reviewer examined discrepancies – was this only on the 20%? Clarity is needed here too.

7. You note the data extraction was carried out by two reviewers – was this independently done and cross-checked or divided equally? Please clarify.

8. Did the two authors collectively develop the descriptive themes, or independently? please clarify. Similarly, were the GRADE-CERQual assessments done collectively or independently and cross-checked?

9. In the results of search section, a sentence should not begin with a numerical digit, that is, if beginning a sentence with a number, the number should be written out in full (e.g., 620 articles, becomes six hundred and twenty…, etc.).

10. I don’t quite understand the inclusion of GRADE-CERQual in Table 2. GRADE-CERQual is applied to discrete findings’ statements, yet here it looks like they are applied to the themes (and unclear if this is the descriptive or analytical theme). What I would suggest is to remove any findings from this Table, and report these in a separate Table with the assessment or certainty. For example, under ‘Importance of screening women early’ there appears to be two separate findings’ statements, but one certainty rating, yet when you read the narrative of the analytical theme ‘Beyond the routine of antenatal screening’ there are certainly more than two discrete findings’ statements identifiable and each of these should be extracted out and subjected to GRADE-CERQual. This goes for the remaining analytical themes and their associated findings. This links to the Appendix, where again it appears the descriptive themes are being subjected to GRADE-CERQual rather than discrete findings. Attention is needed here to adhere to GRADE-CERQual in the assessment of certainty in findings (not themes) and the links between the assessment in the manuscript and that of the evidence profile in the Supp File.

**********

-->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

Reviewer #2: No

Reviewer #3: 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.-->

-->PONE-D-25-01416R2-->-->Sickle cell disease and maternity care: A qualitative synthesis of women’s and health providers experiences.-->-->PLOS One

Dear Dr. Finlayson,

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 Jan 25 2026 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,

Abiola Olukayode Olaleye, MBBS, MPH, FWACP

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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

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 #4: All comments have been addressed

Reviewer #5: (No Response)

Reviewer #6: All comments have been addressed

**********

-->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 #4: Yes

Reviewer #5: Yes

Reviewer #6: Partly

**********

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

Reviewer #4: N/A

Reviewer #5: N/A

Reviewer #6: I Don't Know

**********

-->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 #4: (No Response)

Reviewer #5: No

Reviewer #6: Yes

**********

-->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 #4: Yes

Reviewer #5: Yes

Reviewer #6: No

**********

-->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 #4: I understand that the manuscript has had three reviewers, and I have read your responses to those comments. Although the journal editor invited me to assess the manuscript as a new reviewer, I have carefully considered the previous reviewers' feedback and the authors' responses as part of my peer review.

I appreciate your efforts in seeking to get this qualitative review on sickle cell disease published. It is crucial to highlight the care and understanding of this disease, particularly in sub-Saharan Africa, where it accounts for approximately 80% of global cases. The article presents a comprehensive and insightful synthesis of qualitative literature affected by this complex and often underrepresented condition.

I commend your rigorous methodological approach and the depth of analysis demonstrated throughout the review. Your work significantly contributes to the existing body of knowledge by illuminating the psychosocial dimensions of sickle cell disease, which are frequently overlooked in clinical discourse. The nuanced understanding presented in the review has important implications for both research and practice, particularly in enhancing person-centred care and informing culturally responsive interventions, especially in LMICs.

I found the review to be both intellectually enriching and practically relevant. It will undoubtedly serve as a valuable resource for healthcare professionals, educators, and policymakers committed to improving the quality of life for individuals living with sickle cell disease.

Once again, thank you for your contribution.

Reviewer #5: I appreciate the authors’ efforts in addressing an important and understudied area within sickle cell disease care. The manuscript has the potential to make a meaningful contribution to the literature. Please find my comments below, which I hope will assist in improving the clarity, rigor, and overall quality of the paper.

Abstract

Methods:

1.I recommend rephrasing the statement “We were looking for…” to a more formal description, such as: “Studies reporting qualitative data from … were included.”

Results

1.Consider including the countries of the included studies in parentheses for added clarity.

Introduction

1.Lines 118 – 120. These statements are not clear. Do you mean the disease considerations/ complications impact views on contraception, etc? Please revise for clarity.

Methods

1.Search strategy: Include the full meaning of CNKI at first mention. There are several other instances where acronyms are not fully described initially, or the full description appears after the acronym has already been used. Please review the manuscript and ensure consistency throughout.

2.Study Selection:

a.Is translating text a standard practice in systematic reviews? If so, please provide a supporting reference. Additionally, acknowledge potential limitations of using Google Translate instead of a human translator in the limitations section. Also, indicate which article was translated in the results section (I assume this was Xavier’s article).

b.Lines 193-194: This statement is unclear. Consider rephrasing

c.Indicate whether the review was restricted to original research articles. I noticed that a book (Dyson SM) was included; I have further comments on this in the Results section.

d.Include a statement about whether studies that included women with SCD or SCT alongside those from the general population were eligible. Some included studies appear to involve participants without SCD or SCT. Also, clarify in the data extraction section how you ensured that only data relevant to the review objectives (i.e., from women with SCD or SCT) were extracted.

3.Quality Appraisal:

a.The references cited do not match the provided bibliography. Reference 21 in the bibliography is Bulgin et al, not Walsh and Downe. Please review the entire manuscript to ensure all in-text citations match the reference list.

b.Please provide reference(s) for ‘A-D’ scoring.

c.Line 226 – 229: Include reference(s) for GRADE scoring

Results

1.Line 239 - 240: This statement is not clear. Perhaps you meant to write “did not fulfil the inclusion criteria.”

2.Include citations in the description of all analytic themes. In its current state, readers must refer back to Table 3 to identify sources, which is not ideal.

3.Dyson SM: It is generally not standard practice to include books in systematic reviews, and I have several concerns about the inclusion. Was the book peer-reviewed? Can you identify the chapters that provided the data used in the review? Also, do you have references to justify the inclusion of a book? If not, consider excluding the book from your results.

4.Table 2: Consider revising the table for clarity. Combine author and year into one column (e.g., Cox and Beauquier, 2014). Replace the title column with study aims, as this provides a clearer sense of the study’s focus.

5.Dyson SM et al. 2007: This study included individuals without SCD or SCT. How did you identify observations specific to your population of interest?

6.Table 3: The quote provided from reference 34 (Tsianikas et al, 2012) was not from an individual with SCD or SCT. The paper says that P5 was not a carrier. This goes back to my initial comment: how did you ensure that the data used to generate the themes in this review were from the population of interest? Please address this and review all the provided quotes to ensure that they were from the population of interest.

7.Table 3: Capitalize the “I” in “intense feelings…”

Discussion

1.The introduction of the discussion frames findings as relevant only to women with SCD, whereas most included studies focused on individuals with SCT. Please revise to reflect implications for both groups.

2.There are several grammatical errors in this section; please proofread carefully.

3.Second paragraph: You note a lack of knowledge among affected individuals, then discuss implications for the general population. This transition feels abrupt—consider reorganizing for better flow.

4.Lines 413–415: This statement is unclear. Additionally, the claim that there are no SCD-specific interventions for healthcare providers is incorrect. See Reich et al., 2024 (Pain Management and Nursing). Please revise for accuracy and clarity.

Reviewer #6: This study is a literature review regarding the view and experiences of women with sickle cell trait (SCT) or sickle cell disease (SCD) and their providers during pregnancy. PRISMA method was used. The authors refer this manuscript addresses topics assigned by the World Health Organization. The authors have addressed previous comments. It is hard to follow because of long paragraphs. There is lack of clarity between the women with sickle cell disease and those with sickle cell trait.

Specific comments:

1.Introduction. 3rd Paragraph is very long. Consider breaking it down to several shorter ones.

2.It is difficult to understand the issues affecting women with SCT. Please make clearer what are differences affecting women who have SCT from those who have SCD.

3.In Table 2, the articles appear to be related to women with SCD or general practitioners. Are any of the studies addressing women with SCT? If so, which ones.

4. Please do not use contractions in the manuscript, such as didn’t. Rather use did not.

5.In the discussion, paragraphs are long. Please divide to make them more readable.

6.Conclusion: Not clear whether there is any conclusion regarding women with SCT.

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Reviewer #4: Yes: Adeniyi Olanrewaju Adeleye

Reviewer #5: No

Reviewer #6: No

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Submitted filename: REVIEWER COMMENTS.docx

-->PONE-D-25-01416R3-->-->Sickle cell disease and maternity care: A qualitative synthesis of women’s and health providers experiences.-->-->PLOS One

Dear Dr. Finlayson,

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.

Thank you for providing the revised article and the accompanying details for review.  Overall, most of the previously raised comments appear to have been addressed appropriately. However, two major concerns remain.

First, the language used throughout the manuscript still requires substantial improvement to meet the standards of scholarly writing. In several sections, the authors use first-person expressions such as “we” and “our,” which are generally inappropriate for a scientific manuscript unless specifically permitted by the journal’s style guide. The text should be revised to adopt a more formal, objective, and professional academic tone throughout.

Second, the presentation of the qualitative analysis remains insufficiently developed. Although one table has been included to summarise responses and their interpretation, the analysis would benefit from clearer and more comprehensive presentation, such as in tabular, graphical, or other visual formats. At present, the qualitative findings do not yet provide a complete or fully coherent picture of the analytical process and results.

In addition, careful attention should be given to the journal’s formatting and editing requirements. The manuscript should be revised for consistency in font style, font size, and overall presentation.

-->-->Please submit your revised manuscript by May 08 2026 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Abiola Olukayode Olaleye, MBBS, MPH, FWACP

Academic Editor

PLOS One

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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 #5: All comments have been addressed

Reviewer #7: All comments have been addressed

**********

-->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 #5: Yes

Reviewer #7: Yes

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

Reviewer #5: N/A

Reviewer #7: 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 #5: Yes

Reviewer #7: Yes

**********

-->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 #5: Yes

Reviewer #7: 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 #5: I thank the authors for addressing all the comments. I believe this is very important and needed work, and I thank them once again for taking the initiative to do it.

Reviewer #7: Thank you for sharing all the relevant details for the review.

In this article there seems to be 2 major lackings, one is that the language is very unprofessional, refereing to self and using the terms we, our, etc is not the appropriate language for scientific article.

Secondly, the qualitative analysis should be presented in a tabular or graphical or pictorial form to make sense of the analysis and the process is clear. Although they have included one table representing different responses and analysis but something is missing, it doesnt give a completed sense.

All the other comments are well adjusted and revised appropriately.

Make sure to follow the guidelines for formating and editing os the text and similar font and size should be used.

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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 #5: No

Reviewer #7: Yes: Fatima Afsar

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[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.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

-->

Sickle cell disease and maternity care: A qualitative synthesis of women’s and health providers experiences.

PONE-D-25-01416R4

Dear Dr. Finlayson,

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,

Emma Campbell, Ph.D

Staff 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 #7: All comments have been addressed

**********

-->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 #7: Yes

**********

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

Reviewer #7: 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 #7: Yes

**********

-->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 #7: No

**********

-->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 #7: no comments. The article is now good to go. I have noticed that the author has incorporated the language issues and also the qualitative analsysis is represented in a better way.

**********

-->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 #7: Yes: Fatima Afsar

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