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The manuscript was revised according to the reviewer's suggestion, and I confirm that it is now acceptable for publication
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The paper meets the requirements.
After careful revision, the quality of the article has significantly improved. The author gave good answers to my questions. The paper has met this journal's publication requirements, and I suggest that it be accepted directly.
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Yes
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YES
Please revise carefully according to the reviewer's suggestion.
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1. The authors selected ten cohort studies in total but mentioned that there were “four prospective cohort studies and five retrospective studies”. Why? Please explain it in details.（line 160）.
2. Two studies enrolled in this meta-analysis were published in the 1980s. Does this have an impact on the implications of this article for now?
1. Swabs were performed to evaluate the GBS colonization in all the included studies. What are the methods used for identification of GBS? Please include in more details in Table 1.
2. Could difference in genotype of GBS affect the association between GBS colonization and stillbirth? The authors should comment on this issue in the discussion.
3. The limitations of the study should be discussed in more details.
This manuscript is a meta-analysis study to examine the association between maternal rectovaginal Group B Streptococcus (GBS) colonization and the risk of stillbirth. It provides valuable insight into the relationship between GBS colonization and stillbirth risk and indicates directions for future research. However, the authors need to revise the manuscript properly before acceptance.
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Question 1: Before the results, little information about Group B Streptococcus (GBS) was provided, it was suggested that more details of GBS should be introduced before the results part, which would help the reader appreciate the context. In addition, more details are needed in the introduction section to better demonstrate the necessity of the study.
Question 2: There are some grammatical problems in the text, For example, in lines 166-167, "Overall, 806 (0.67%) of the included women had stillbirth during the index pregnancy and the overall incidence of stillbirth varied from 0.06% to 8.53% among the studied cohorts ". In a sentence, the use of" varied "may not be quite accurate, and can be changed to "ranged". Furthermore, in line 124, extra space is added between “m” and “i” in the word “timing”. Such grammatical errors should be carefully checked and corrected to improve the language quality of the article.
Question 3: Although the inclusion and exclusion criteria defined according to the PICOS framework are mentioned, some criteria could be described in more detail. For example, the definition of "comorbidities" could be further clarified to specify which diseases or conditions are comorbidities to avoid possible ambiguity during study selection. Secondly, the NOS was used to evaluate the quality of the studies, but only the scores of each item were listed, without explaining the specific assessment content of the scale and how to judge the quality of the studies according to the score. It is suggested that a brief introduction to the NOS scale be added to enable readers to better understand the basis and reliability of study quality assessment.
Question 4: The high heterogeneity was mentioned in the study, but this was only briefly reported in the results section without exploring the possible causes of heterogeneity in depth. We suggest that the authors refine the content of this article by further exploring the sources of heterogeneity in the discussion.
Question 5:
The title and label of some charts are not clear. For example, in Forest plots, in addition to displaying the OR value and 95% CI, the meaning of these values can be briefly explained in the axis label or legend, so that readers can better understand the content of the chart without referring to the main text.
Question 6:
The authors discuss study limitations without specifically analyzing why these limitations influenced the findings. The potential impact of these limitations on the conclusions of the study, such as possible overestimation or underestimation of the results, and how these effects can be avoided or reduced in future research should be elaborated.
The manuscript is well-organized and demonstrates clear and professional language. The study provides an adequate background, explaining the significance of Group B Streptococcus (GBS) colonization in pregnant women and its potential implications for stillbirth.
The study presents a well-defined and meaningful research question, and it successfully fills an important knowledge gap. The investigation appears rigorous, using appropriate statistical methods and a comprehensive literature review to ensure a high technical standard. The methods section is sufficiently detailed for replication.
The study is aimed to address an important clinical issue, but its novelty may not be immediately clear without an explicit discussion of how it advances the literature beyond simply aggregating existing findings. The underlying statistical methods are sound, and the conclusions are linked to the research question.
This study investigates the potential association between maternal rectovaginal Group B Streptococcus (GBS) colonization and the risk of stillbirth through a meta-analysis of observational studies. The authors conducted a comprehensive literature search across multiple databases, including PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure, covering studies up to September 2024. A total of ten studies, including 121,195 pregnant women, were included in the analysis. The pooled results indicated no significant overall association between maternal GBS colonization and the risk of stillbirth. However, sensitivity analyses showed a significant association in studies that involved intrapartum antibiotic prophylaxis (IAP).
In conclusion, the manuscript addresses an important question regarding maternal rectovaginal GBS colonization and stillbirth risk. It provides useful insights but could benefit from improved clarity in the abstract, additional explanations of statistical findings, and further discussion of study limitations and implications for clinical practice.
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