Title: Pregnancy Outcomes in Women with Celiac Disease in Northeast Iran: A Regional
Retrospective Cohort Study
Version: 2 Date: 12 Feb 2024
Reviewer's report:
This paper investigated pregnancy outcomes in Iranian women with celiac disease compared to
without. I have some major concerns with this paper that leads to my recommendation to reject
this paper.
1. Figure 1, the selection process, matching and exclusion is not clear and easy to follow when
looking at Figure 1 together with the text. Were there only 61 pregnancies in the 982 women with
celiac disease from the celiac center? That seems like a very low number. What was the age of
all those excluded women with celiac disease– where they girls and therefor not in childbearing
age?
2. There is no descriptive data of the exposed population in relation to their celiac disease – how
long had they been diagnosed? Where they adhering to the gluten-free diet? Non-adherence is
very common and would make a large impact on pregnancy outcomes.
3. There is no clear definition of the unexposed group – How were they chosen? Were they in
any way matched? how did you know these did not have celiac disease as this is a diagnosis that
is commonly unrecognized, and would that make an impact on your findings?
4. Statistical analysis – it is not clear at all how the authors modelled the association analysis.
Were there several analyses were celiac disease (0/1) was used as the dependent variable and
one independent outcome variable?  And, they did not do any analyses for outcomes that were
not present in the exposed group but rather in the unexposed group. It is not stated in the methods
section or anywhere in the manuscript what the analyses were adjusted for and why.
5. It is not clear what outcomes the authors were interested in when reading the paper – it is not
consistent when reading the Methods Defining the outcomes and reading the results and tables.
Other concerns:
1. What is the problem with older ICD codes of celiac disease? If biopsy diagnosed – should
this pose a problem? And diagnosis based on serology is well established in children in Europe,
but as we don’t have information on the CD group in the paper, it is not possible to draw a
conclusion if the diagnosis were correct or not in this study either.
2. Mainly in the introduction, but also in the rest of the manuscript, there are no references for
several statements.
3. The introduction and discussion are unstructured.
4. Check spelling, grammar, tempus.
5. No line numbers
6. Suggest to do a table on the outcomes
Title: Pregnancy Outcomes in Women with Celiac Disease in Northeast Iran: A Regional
Retrospective Cohort Study
Version: 2 Date: 12 Feb 2024
Reviewer's report:
This paper investigated pregnancy outcomes in Iranian women with celiac disease compared to
without. I have some major concerns with this paper that leads to my recommendation to reject
this paper.
1. Figure 1, the selection process, matching and exclusion is not clear and easy to follow when
looking at Figure 1 together with the text. Were there only 61 pregnancies in the 982 women with
celiac disease from the celiac center? That seems like a very low number. What was the age of
all those excluded women with celiac disease– where they girls and therefor not in childbearing
age?
2. There is no descriptive data of the exposed population in relation to their celiac disease – how
long had they been diagnosed? Where they adhering to the gluten-free diet? Non-adherence is
very common and would make a large impact on pregnancy outcomes.
3. There is no clear definition of the unexposed group – How were they chosen? Were they in
any way matched? how did you know these did not have celiac disease as this is a diagnosis that
is commonly unrecognized, and would that make an impact on your findings?
4. Statistical analysis – it is not clear at all how the authors modelled the association analysis.
Were there several analyses were celiac disease (0/1) was used as the dependent variable and
one independent outcome variable?  And, they did not do any analyses for outcomes that were
not present in the exposed group but rather in the unexposed group. It is not stated in the methods
section or anywhere in the manuscript what the analyses were adjusted for and why.
5. It is not clear what outcomes the authors were interested in when reading the paper – it is not
consistent when reading the Methods Defining the outcomes and reading the results and tables.
Other concerns:
1. What is the problem with older ICD codes of celiac disease? If biopsy diagnosed – should
this pose a problem? And diagnosis based on serology is well established in children in Europe,
but as we don’t have information on the CD group in the paper, it is not possible to draw a
conclusion if the diagnosis were correct or not in this study either.
2. Mainly in the introduction, but also in the rest of the manuscript, there are no references for
several statements.
3. The introduction and discussion are unstructured.
4. Check spelling, grammar, tempus.
5. No line numbers
6. Suggest to do a table on the outcomes
Please review this paper.
user
Title: Pregnancy Outcomes in Women with Celiac Disease in Northeast Iran: A Regional
Retrospective Cohort Study
Version: 2 Date: 12 Feb 2024
Reviewer's report:
This paper investigated pregnancy outcomes in Iranian women with celiac disease compared to
without. I have some major concerns with this paper that leads to my recommendation to reject
this paper.
1. Figure 1, the selection process, matching and exclusion is not clear and easy to follow when
looking at Figure 1 together with the text. Were there only 61 pregnancies in the 982 women with
celiac disease from the celiac center? That seems like a very low number. What was the age of
all those excluded women with celiac disease– where they girls and therefor not in childbearing
age?
2. There is no descriptive data of the exposed population in relation to their celiac disease – how
long had they been diagnosed? Where they adhering to the gluten-free diet? Non-adherence is
very common and would make a large impact on pregnancy outcomes.
3. There is no clear definition of the unexposed group – How were they chosen? Were they in
any way matched? how did you know these did not have celiac disease as this is a diagnosis that
is commonly unrecognized, and would that make an impact on your findings?
4. Statistical analysis – it is not clear at all how the authors modelled the association analysis.
Were there several analyses were celiac disease (0/1) was used as the dependent variable and
one independent outcome variable?  And, they did not do any analyses for outcomes that were
not present in the exposed group but rather in the unexposed group. It is not stated in the methods
section or anywhere in the manuscript what the analyses were adjusted for and why.
5. It is not clear what outcomes the authors were interested in when reading the paper – it is not
consistent when reading the Methods Defining the outcomes and reading the results and tables.
Other concerns:
1. What is the problem with older ICD codes of celiac disease? If biopsy diagnosed – should
this pose a problem? And diagnosis based on serology is well established in children in Europe,
but as we don’t have information on the CD group in the paper, it is not possible to draw a
conclusion if the diagnosis were correct or not in this study either.
2. Mainly in the introduction, but also in the rest of the manuscript, there are no references for
several statements.
3. The introduction and discussion are unstructured.
4. Check spelling, grammar, tempus.
5. No line numbers
6. Suggest to do a table on the outcomes
assistant