Impact of Prenatal Health Conditions and Health Behaviors in Pregnant Women on Infant Birth Defects in the United States Using CDC-PRAMS 2018 Survey

Round 1

Reviewer 1 Report

Very interesting and well written manuscript. Only one minor correction should be carried out:

Abstract - line 25: please rephrase: The results indicate that birth defects in the United States can be lowering Depression in pregnant women.

 

 

Author Response

Thank you for your comment. I implemented the suggested changes. 

Reviewer 2 Report

The concept is interesting and the quality of the research data subject appears to be high. While the statistical methods, taking into consideration confounding factors, are commendable, but the background and approach are insufficiently mature. It is merely a processing of a big amount of data and lacks scientific ideas and approaches. For this reason, the paper is considered insufficient for publication in the journal concerned.

Author Response

I revised my paper according to your suggestion and included more background and a literature review. I hope this is consistent with the topic and analysis that were done.

I included more detailed information about all the risk factors including diabetes during pregnancy, maternal depression, and smoking during pregnancy. The added literature review provides justification for the risk factors and research question.

Reviewer 3 Report

Dear authors,

Results must be presented in better form. Diabetes criteria must be clarified. There is no explanation of the previous studies connecting depression with birth defects (only with adverse outcomes) both in introduction and discussion. There are very confusing results about incomes and race, please clarify the results that are relevant.

In the introduction first paragharph is also confusing (3.2 mil of chlidren being born- I suppose with birth defects). The sentence on oral health and public health costs should be improved with more respect to that children and their families.

Please check the grammar and spelling (Depression with big D?).

Best regards. 

Author Response

I reviewed all your suggestions and included changes in my new draft. I am thankful for your comments. 

 

The new research draft describes the diabetes criteria in more detail.

Method section:

“.          The “diabetes during pregnancy variable” classification is different. The PRAMS data set combined all the types of diabetes together including Type 1. Type 2, gestational diabetes. The diabetes during pregnancy variable in this data set is binary showing “Yes” and “No”. The pregnant mother who responded yes reflects diabetes which includes Type 1, Type 2, and gestational diabetes. The data were analyzed using SPSS, Version 26 (SPSS, 2020).

Discussion section:

These contradicting results might be due to lower cases of pregnant women diagnosed with type 1 and type 2 diabetes. Gestational diabetes cases might have contributed more to the sample of diabetes, which resulted in contradicting results as gestational diabetes does not have a stronger association with birth defects [9]. This study used the already collected survey data by CDC-PRAMS, so it was not possible to separate the diabetes cases in gestational or non-gestational diabetes. For future studies, this variable should be reclassified to understand the impact of different types of diabetes on birth defects.

 

 

There is no explanation of the previous studies connecting depression with birth defects (only with adverse outcomes) both in introduction and discussion.

Introduction:

Likewise, prenatal depression among pregnant women poses a comprehensive public health problem and is a potential risk factor for adverse birth outcomes [8]. A cross-sectional study conducted in Wuhan, China, between March 2013 and April 2014 suggested that prenatal depression was significantly associated with birth defects. The adjusted odds ratio for this variable was 1.67 compared with women reporting no prenatal depression; however, no temporal relationship could be established since it was a cross-sectional study [8, 9]. This reflects the association between maternal depression and birth defects [8]. The study concluded that reducing maternal depression can significantly reduce the risk of birth defects. [80

Although previous studies have addressed the impact of prenatal health conditions and health behaviors on birth defects, they did not assess the interactive effect of these variables on birth defects. This study aims to address the gaps in the literature by understanding both the individual and interactive effects of smoking during pregnancy, diabetes, and prenatal depression on birth defects. The study aims at finding the risk of delivering a child with birth defect in women with depression, diabetes, and health behaviors like smoking. 

In the introduction first paragharph is also confusing (3.2 mil of chlidren being born- I suppose with birth defects). The sentence on oral health and public health costs should be improved with more respect to that children and their families.

Birth defects affect the quality of life of these infants and pose a burden for their fami-lies and society. According to the World Health Organization (WHO), About 300,000 newborns diagnosed with birth defects die within the first 28 days of life [1]. Approxi-mately 3.3% of live births in the United States constitute severe birth defects [1]. Birth defects result in an increased cost of care for children born with a birth defect com-pared to those with no birth defects [2]. The increased cost of care affects access to oral health care for children with birth defects [2].

Round 2

Reviewer 2 Report

I think it's been corrected appropriately.

Reviewer 3 Report

Please do the spell check once again.