Reviewer’s report
Title: 
A potential role for insulin treatment during pregnancy in reducing postpartum psychological
distress in maternal obesity: An administrative population health study
Version: 
0 
Date: 
07 Sep 2020
Reviewer's report:
Thank you for inviting me to review this manuscript. This study highlight an important issue face by many
pregnant women whom their anthropometric characteristic was at higher risk of adverse pregnancy
outcomes. This study examined maternal obesity and risk of postpartum depression as the primary
objective and secondary objective was to determine effect of insulin on risk reduction of postpartum
depression. I have several suggestion for authors: 
ABSTRACT
1. Objective was not clearly stated
2. Method should be rephrased and reorganized in a concise and precise manner. Eliminate those
unnecessary informtion 
3. Result was appropriate
4. Conclusion should clearly stated obese women with GDM or otherwise it will mislead why obese
women were on insulin treatment. 
INTRODUCTION
5. Lack of coherent and certain paragraphs mention treatment for depression which i personally think they
are not related to the objectives. 
6. The introduction should be rewritten as such: Prevalence of obesity in pregnancy, maternal obesity is a
risk factor more multiple adverse pregnancy outcomes, which increase morbidity and mortality. 
What are
the risk factor for obese women with GDM, how about non obese GDM women? Adverse pregnancy
outcomes usually seen in obese women with GDM (provide relative risk or odd ratio if there is relevant
data). 
7. State the objective in a concise and precise manner. 
METHOD
8. Lack of information on study design, screening criteria for obesity and GDM/ 
9. What kind of data were captured from respondents from electronic databases or medical record. What
other factors were considered for analysis. 
9. Ethics clearance for conducting this retrospective cohort or prospective cohort. 
10. Study sample size calculation was absence 
11. Unclear method of analysis for univariate and multivariate regression, what variables were included in
the final model and what criteria these factors shall meet in order to enter multivariate. 
RESULT
12. Table 1 lack of basic sociodemographic information
13. Table 2 should present univariate analysis stratified by lean versus obese with and without insulin
treatment. 
14. Table 3 what variables were adjusted for rate ratio of postpartum psychological distress
15. Table in page 12 (without table number), this should highlight which was the reference and which was
the at risk group. 
DISCUSSION
16. Please mention the objective to refresh reader memory
17. Stated the key finding and provide explanation for why insulin could reduce risk of postpartum
psychological distress, what are the mechanism behind this finding
18. Please state the strength of your study before limitation. 
CONCLUSION
19. Please offer concise and precise conclusion which was found from your study and do not over-write. 
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Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this manuscript,
either now or in the future?
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from the publication of this manuscript, either now or in the future?
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Do you hold or are you currently applying for any patents relating to the content of the manuscript?
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Have you received reimbursements, fees, funding, or salary from an organization that holds or has
applied for patents relating to the content of the manuscript?
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Do you have any other financial competing interests?
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Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If your
reply is yes to any, please give details below.
I declare that I have no competing interests
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Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes