Title: Pregnancy Outcomes in Women with Celiac Disease in Northeast Iran: A Regional
Retrospective Cohort Study
Version: 2 Date: 07 Feb 2024
Reviewer's report:
I would like to commend the authors for this interesting single center review which compares
pregnancy outcomes in women with celiac disease with an age, geographic and socio-economic-
matched control group of pregnant women without celiac disease using electronic public health
records in Iran. The study design and analysis are robust, addressing the outlined deficiencies
could significantly strengthen the manuscript.
- I understand English is not the first language of the authors but at times the language is
confusing and not clear and would benefit from a review.
- can the authors comment on why pregnancies by assisted reproductive methods were excluded
and could this impact the generalizability of the study? Could this also introduce a bias in their
study, as women utilizing assisted reproduction are in general from a higher socio-economic
class, which is often associated with better access to medical care and healthcare utilization/
compliance.
- the authors claim to have matched the study participants by geographic and socio-economic
factors but do not provide any evidence to support this.
- I would use the term 'miscarriage' rather than 'abortion' in the manuscript.
- I do not fully understand the inclusion criteria. A total of 534K pregnancy records were
examined - which if we apply an expected 1% incidence rate of celiac disease should give
approximately 5,340 cases. How did the authors identify the 61 pregnancies included? The flow
chart is confusing and needs to be re-arranged.
- An important omission is any measure of disease activity in the pregnant women with celiac
disease? I agree that serology/TTG is not necessarily a good measure of disease activity, however
information on compliance/adherence to GFD, symptomatology/ micronutrient status/ evidence
of mucosal healing on histopathology would strengthen the study. An important message in
previous studies has been the impact of undiagnosed or poorly controlled celiac disease on
pregnancy outcomes. Could the absence of any significant difference in this study be due to the
absence of disease activity in the celiac group?
- Some of the abbreviations in the table (i.e. FGS, OGTT) need to be explained in the text/table.
Title: Pregnancy Outcomes in Women with Celiac Disease in Northeast Iran: A Regional
Retrospective Cohort Study
Version: 2 Date: 07 Feb 2024
Reviewer's report:
I would like to commend the authors for this interesting single center review which compares
pregnancy outcomes in women with celiac disease with an age, geographic and socio-economic-
matched control group of pregnant women without celiac disease using electronic public health
records in Iran. The study design and analysis are robust, addressing the outlined deficiencies
could significantly strengthen the manuscript.
- I understand English is not the first language of the authors but at times the language is
confusing and not clear and would benefit from a review.
- can the authors comment on why pregnancies by assisted reproductive methods were excluded
and could this impact the generalizability of the study? Could this also introduce a bias in their
study, as women utilizing assisted reproduction are in general from a higher socio-economic
class, which is often associated with better access to medical care and healthcare utilization/
compliance.
- the authors claim to have matched the study participants by geographic and socio-economic
factors but do not provide any evidence to support this.
- I would use the term 'miscarriage' rather than 'abortion' in the manuscript.
- I do not fully understand the inclusion criteria. A total of 534K pregnancy records were
examined - which if we apply an expected 1% incidence rate of celiac disease should give
approximately 5,340 cases. How did the authors identify the 61 pregnancies included? The flow
chart is confusing and needs to be re-arranged.
- An important omission is any measure of disease activity in the pregnant women with celiac
disease? I agree that serology/TTG is not necessarily a good measure of disease activity, however
information on compliance/adherence to GFD, symptomatology/ micronutrient status/ evidence
of mucosal healing on histopathology would strengthen the study. An important message in
previous studies has been the impact of undiagnosed or poorly controlled celiac disease on
pregnancy outcomes. Could the absence of any significant difference in this study be due to the
absence of disease activity in the celiac group?
- Some of the abbreviations in the table (i.e. FGS, OGTT) need to be explained in the text/table.
Please review this paper.
user
Title: Pregnancy Outcomes in Women with Celiac Disease in Northeast Iran: A Regional
Retrospective Cohort Study
Version: 2 Date: 07 Feb 2024
Reviewer's report:
I would like to commend the authors for this interesting single center review which compares
pregnancy outcomes in women with celiac disease with an age, geographic and socio-economic-
matched control group of pregnant women without celiac disease using electronic public health
records in Iran. The study design and analysis are robust, addressing the outlined deficiencies
could significantly strengthen the manuscript.
- I understand English is not the first language of the authors but at times the language is
confusing and not clear and would benefit from a review.
- can the authors comment on why pregnancies by assisted reproductive methods were excluded
and could this impact the generalizability of the study? Could this also introduce a bias in their
study, as women utilizing assisted reproduction are in general from a higher socio-economic
class, which is often associated with better access to medical care and healthcare utilization/
compliance.
- the authors claim to have matched the study participants by geographic and socio-economic
factors but do not provide any evidence to support this.
- I would use the term 'miscarriage' rather than 'abortion' in the manuscript.
- I do not fully understand the inclusion criteria. A total of 534K pregnancy records were
examined - which if we apply an expected 1% incidence rate of celiac disease should give
approximately 5,340 cases. How did the authors identify the 61 pregnancies included? The flow
chart is confusing and needs to be re-arranged.
- An important omission is any measure of disease activity in the pregnant women with celiac
disease? I agree that serology/TTG is not necessarily a good measure of disease activity, however
information on compliance/adherence to GFD, symptomatology/ micronutrient status/ evidence
of mucosal healing on histopathology would strengthen the study. An important message in
previous studies has been the impact of undiagnosed or poorly controlled celiac disease on
pregnancy outcomes. Could the absence of any significant difference in this study be due to the
absence of disease activity in the celiac group?
- Some of the abbreviations in the table (i.e. FGS, OGTT) need to be explained in the text/table.
assistant