All reviews of published articles are made public. This includes manuscript files, peer review comments, author rebuttals and revised materials. Note: This was optional for articles submitted before 13 February 2023.
Peer reviewers are encouraged (but not required) to provide their names to the authors when submitting their peer review. If they agree to provide their name, then their personal profile page will reflect a public acknowledgment that they performed a review (even if the article is rejected). If the article is accepted, then reviewers who provided their name will be associated with the article itself.
Dear authors,
Both reviewers are happy with the revisions conducted. I am now accepting your manuscript for publication. congratulations!
[# PeerJ Staff Note - this decision was reviewed and approved by Celine Gallagher, a PeerJ Section Editor covering this Section #]
Have no further comments after the changes have been made.
Have no further comments after the changes have been made.
Have no further comments after the changes have been made.
Have no further comments after the changes have been made.
This revised manuscript was very well-written and easy to understand. All of my comments were addressed appropriately. I have no further suggestion. This manuscript is ready to be published.
The study design was improved accordingly.
The findings were valid and support the conclusion.
Dear authors,
Thank you for your submission.
Improvements are needed to enhance the clarity of the methodological approach and data analysis. Please, refer to the reviewers' comments for further details.
**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.
The paper lacks clarity. The lack of clarity is partly due to grammatical problems. However, it also suffers lack of clarity in the method and material section, or in developing hypotheses. I have put comments in the PDF version of the submitted paper. An example is that they have not elaborated on the confounding variable, although they have said they reviewed literature and used appropriate statistical tests to control for the confounding variables.
The research questions are clear. However, the method and material section is not. I have put my comments in the pdf file.
Reviewing the supplemental material did actually increase my confusion. There were inconsistencies, at least to my understanding, regarding the numbers of the cases (I have commented on it in the PDF file). The hypothesis of the impact of psychological problems on negative pregnancy outcomes needs clarification, as the authors have mentioned that GH is a risk factor for psychological distress and GH has a negative impact on pregnancy outcomes. How did they control for the impact of GH on negative outcomes when it is a risk factor for psychological distress itself?
The manuscript was well-written in English, with sufficient literary references and contextual support. It was also well-formatted, and the hypothesis and objectives were clearly stated.
1. How were the cases and controls matched? You mentioned key potential confounding factors—please specify which confounders were used for matching and describe the matching process (e.g., frequency matching or exact matching). Additionally, how were the cases selected? Were all patients with GH during the study period included, or was a random selection method used? If random selection was applied, please provide the total number of GH patients admitted during that period to establish the basis for selection. Furthermore, Figure 1 lacks information regarding the initial (larger) pool of patients from which the cases and controls were drawn.
2. Why was the SAS score used to assess psychological distress instead of other scoring methods? Does SAS offer specific advantages, or was its use based on prior studies? Please clarify.
3. Please specify the follow-up duration from inclusion to delivery. As reported, there was no loss to follow-up—can you confirm if this is accurate? If so, how was complete follow-up ensured?
1. Please merge Tables 1 and 2 into a single table, as separating one finding into Table 2 is unnecessary.
2. In Table 4, according to your statistical approach (including covariates with p<0.1 in the multivariable regression), please clarify why thyroid disease was not included in the regression analysis despite meeting this criterion. In the case that thyroid disease fell out while using backward stepwise regression, please clarify.
3. Please specify in the titles of Tables 5 and 6 that they present a subgroup analysis of patients with GH. Additionally, could you perform a similar analysis for the control group (patients without GH) and compare the findings with the GH group?
4. The content in lines 197 to 201 should be moved to the "Methods" section, as it does not belong in the "Results" section.
5. Section 4.1 should be more concise and integrated with the "Limitations" section to form a new section titled "Limitations and Strengths."
All text and materials provided via this peer-review history page are made available under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.