PWAT-D-23-00137

Unregulated drinking water contaminants and adverse birth outcomes in Virginia

PLOS Water

Dear Dr. Young,

Thank you for submitting your manuscript to PLOS Water. After careful consideration, we feel that it has merit but does not fully meet PLOS Water'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.

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EDITOR:

Additionally, there is a missed opportunity for a comparative assessment with regulated contaminants, limiting the contextual understanding of risks. The geographic specificity to Virginia raises concerns about the generalizability of findings to a national scale. Inconsistencies in statistical significance and challenges in risk communication further diminish the robustness and practical relevance of the reported associations. The study also assumes exposure homogeneity within estimated service areas, potentially leading to exposure misclassification. Lastly, reliance on the National Contaminant Occurrence Database introduces a dependency on the accuracy and completeness of this data source, which may have its own limitations.

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Please submit your revised manuscript by Jan 19 2024 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 water@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pwat/ 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 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'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Venkatramanan Senapathi, Ph.D.

Academic Editor

PLOS Water

Journal Requirements:

Additional Editor Comments (if provided):

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Water’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. 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

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

PLOS Water 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

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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: It is an interesting study where authors investigated association between drinking water contaminants and adverse birth outcomes. However, this is an ecological study so interpretation should be done with caution because of lots confounders. There are some technical issues should be addressed further if a revision will be invited.

1. A key issue is whether UCMR 3 were measured during 2008-2010, if yes, when analyzing UCMR2, UCMR3 should be controlled. The same thing is to analysis of UCMR3. No measurement means zero level? If not, this issue is important limitation.

2. The confounders presented in part of methods is different those in table 4. What is majority gestational year? Maybe year of birth should be adjusted.

3. In fact, authors seemed not to control gestational age of baby, which is key factor affecting birth outcomes. Why?

4. It is little confusing for me about period of exposure of water contaminants. Authors seems not to assign contaminants to each trimester of pregnancy. Instead, they found mid-trimester for each mother, right? It seems not. Authors are suggested to present this issue more clearly.

5. No methods are presented in methodology for figure 4. It seems to be stratified analysis by region, right?

Reviewer #2: Review PWAT-D-23-00137

General Comments and Recommendations

The manuscript entitled, “Unregulated drinking water contaminants and adverse birth outcomes in Virginia”, presents the results of a study examining the association between birth outcomes including low birthweight (LBW), pre-term birth (PTB), and term low birthweight (tLBW). Birth records were geolocated and essentially, “mapped” against the results of EPA sampling and analysis for specific waterborne contaminants under the Unregulated Contaminant Monitoring Rule (UCMR). The authors found that birth outcomes were largely unaffected or not associated with most of the contaminants examined under the UCMR. Two contaminants N-Nitroso-dimethylamine and chlorodifluoromethane were positively associated with PTB and tLBW respectively suggesting that these compounds negatively affect these birth outcomes. Two other “constituents” molybdenum and vanadium were negatively associated with LBW, molybdenum was also negatively associated with tLBW suggesting these elements might play a protective role against these adverse birth outcomes. This study is straightforward, the manuscript is well-written, the methods used are appropriate, and the authors present a comprehensive overview of its limitations. I suggest some very minor revisions, see below, and then recommend the manuscript for publication.

Specific Comments, Questions, and Recommendations

Replace contractions with full words.

Data and Methods

L167-169: Sentences appear to be repetitious and incomplete.

Discussion

L299-301: This may be true, but the finding of this group suggests these 2 metals are protective. I suggest rewording to indicate that studies need to examine the potential benefits of these metals. As written, the implication leans one toward the potential negative impacts.

Conclusion

L341-L344: I suggest you just state the 2 contaminants that were positively associated with poor birth outcomes.

L349-L352: To be fair, the study found that only 2 contaminants appeared to negatively impact birth outcomes. I would just state those 2. The study actually found that most of the known contaminants did not appear to negatively impact birth outcomes and 2 elements may indeed positively affect birth outcomes. I suggest rewording to stay within what this study found.

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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.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Jeffrey K. Wickliffe

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Attachments

Attachment

Submitted filename: Review PWAT-D-23-00137.pdf

Unregulated drinking water contaminants and adverse birth outcomes in Virginia

PWAT-D-23-00137R1

Dear Miss. Young,

We are pleased to inform you that your manuscript 'Unregulated drinking water contaminants and adverse birth outcomes in Virginia' has been provisionally accepted for publication in PLOS Water.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow-up email from a member of our team. 

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

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 water@plos.org.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Water.

Best regards,

Venkatramanan Senapathi, Ph.D.

Academic Editor

PLOS Water

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Reviewer Comments (if any, and for reference):

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: (No Response)

Reviewer #2: All comments have been addressed

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2. Does this manuscript meet PLOS Water’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

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

Reviewer #1: (No Response)

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. 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 Response)

Reviewer #2: Yes

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

PLOS Water 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 Response)

Reviewer #2: 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: Authors have addressed most of my comments, and the mauscript has been improved.

Reviewer #2: N/A

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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.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Jeffrey K. Wickliffe

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