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Dear Dr. Yang,
Thank you for submitting the revised version of your manuscript. After a thorough review of the changes by the reviewers and me, I am pleased to inform you that all the reviewers' comments have been adequately addressed. Therefore, your manuscript is ready for publication in PeerJ.
Sincerely yours,
Stefano Menini
[# PeerJ Staff Note - this decision was reviewed and approved by Celine Gallagher, a PeerJ Section Editor covering this Section #]
The authors have addressed all the comments, and the quality of the article has improved. Well done
The authors have addressed all the comments, and the quality of the article has improved. Well done
They have addressed all the comments
Please revise in accordance with the reviewers' feedback.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
I would like to express my congratulations for all laborious efforts the authors undertook to complete the study and to prepare the manuscript. However, I have some comments that I believe will assist the authors to improve the content.
The study has an originality while the research group designed a study with real world data collected from hospitals that provide health support to citizens and even more the field that they performed their study needs more scientific information to be added.
The research questions were set properly, and they were meaningful. Data was collected retrospectively and as authors stated there were missing values but not many enough to interfere with the validity of the study results. However, I have a concern regarding the omission of abortion and stillbirth cases from the study findings. We are aware that free fatty acids play crucial role in the development and health of the placenta and when failed the fetus cannot survive (https://doi.org/10.1016/j.plefa.2020.102080). Even more regarding the statistical analysis we have no information regarding the median values which are considered more representative when they deviate a lot from the mean values.
The study protocol was approved by the IRB of Peking University and the methods described with sufficient detail & information to replicate.
I would like to express my congratulations for all laborious efforts the authors undertook to complete the study and to prepare the manuscript. However, I have some comments that I believe will assist the authors to improve the content.
The study has an originality while the research group designed a study with real world data collected from hospitals that provide health support to citizens and even more the field that they performed their study needs more scientific information to be added.
The research questions were set properly, and they were meaningful. Data was collected retrospectively and as authors stated there were missing values but not many enough to interfere with the validity of the study results. However, I have a concern regarding the omission of abortion and stillbirth cases from the study findings. We are aware that free fatty acids play crucial role in the development and health of the placenta and when failed the fetus cannot survive (https://doi.org/10.1016/j.plefa.2020.102080). Even more regarding the statistical analysis we have no information regarding the median values which are considered more representative when they deviate a lot from the mean values.
The study protocol was approved by the IRB of Peking University and the methods described with sufficient detail & information to replicate.
The results are clearly stated, and they were somehow in relevance to the existing literature. In the discussion section I feel that the text lacks explanatory information for the study findings.
For example, we do know that the high fetal insulin levels triggered by the increased glucose load delivered by the placenta from a hyperglycemic mother and this explains the increased LGA to the increased GHbA1c during the last trimester. Alongside, while fatty acids are transferred through the placenta must have some fetal implications that the study is presenting in the manuscript (https://doi.org/10.3945/ajcn.110.001230) but with possible epigenetic effects (https://doi.org/10.1038/s41366-021-00781-x) with antenatal child obesity. I expect the discussion to be further enriched in this manner.
**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful.
I suggest correcting in the title “diabetes mellitus” instead of “diabetes”. The word “plasma” in the abstract (4rth line from the bottom and in line 36 ). Finally the text needs editing from a natively speaking the English language editor in order to further improve its appearance.
Title: It would be better to include the country and study design to provide more context.
Introduction: Consider elaborating on the importance of conducting this research both nationally and internationally to emphasize its broader relevance and potential impact.
Results: Did you record participants' drug consumption before and during pregnancy? Additionally, did you account for lifestyle factors such as weight gain during the trimesters and ethnicity? Previous literature suggests that these factors may be related to the occurrence of larger babies. If these data were collected, it would be beneficial to check for any linear relationships between these variables. If any relationships are found, please include them in your model.
Without controlling for these factors, it may not be accurate to conclude that "elevated plasma glucose and lipid levels at different pregnancy stages were independently linked to adverse outcomes." If lifestyle factors and drug usage were not considered, this should be acknowledged as a limitation of your study.
Since you collected all the data from previous records, some bias could have occurred, especially research bias. It would be worth mentioning how you controlled for these biases.
No comments
After addressing the comments validity of the findings could be increased
Good study
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