Reviewer's report 
 Obstetric prognosis in sisters of preeclamptic women - implications for genetic linkage studies Title: 
Authors: 
Dr Nonna Heiskanen ( nonna.heiskanen@kuh.fi )
Prof Seppo Heinonen ( seppo.heinonen@kuh.fi )
Pertti Kirkinen ( pertti.kirkinen@pshp.fi )
 2  4 Jan 2003 Version: Date: 
 Dr Svein Rasmussen Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Unable to decide on acceptance or rejection until the authors have Advice on publication: 
responded to the compulsory revisions 
Comments on the revised manuscript 
The authors have extensively revised the manuscript and it has its potential. Still, much work 
remains, especially with the Discussion, which is the weak part, before the paper is acceptable. 
Although the paper has been through a language revision, the authors should work throughout the 
article sentence by sentence, making formulations clearer. 
Background 
"...implying that genes are" " of preeclampsia. Women above" 
Last line: 
" Data is useful not only for scientific but also for counselling purposes. " This may by understood as 
data in general is useful for... This is not a big deal, but exemplifies that the authors should place 
effort in reading and thinking over each sentence. Suggestion "Such data is useful ......." 
Materials and methods: 
2nd line of 2nd paragraph: "(Nonna tarkista)"? 2nd line, 3rd paragraph: ">300" should be corrected to "[greater than or equal to]300". 
Last line, 3rd pararagraph " Comparison of different classification ..... blood pressure [13]." I suggest 
that this sentence be deleted. 
Page 5, 2nd paragraph: 
"...small-for-gestational -age delivery (below the normal 10th percentile according to our own records), low birth weight (newborn weight less than 2500 g).." -reiteration. Reference material values for the birth weight percentiles were obtained from own records [14]. 
Last paragraph: "Differences between study subjects ................tests, as when appropriate." 
Discussion 
The discussion is rather unstructured and needs revision. 
Main points in a discussion outlined by Docherty M, Smith R (The case for structuring the discussion 
of scientific papers. BMJ 1999 May 8;318:1224-5.) could be helpful: 
*Statement of principal findings 
*Strengths and weaknesses of the study *Strength and weaknesses in relation to other studies, discussing any differences in results (compare strengths and weaknesses) 
*Meaning of the study: possible mechanisms in results 
explanation of the findings. What might they mean for clinicians? * Unanswered questions and future research 
A substantial part of the Discussion ("Clinically, affected versus unaffected status appears to be 
clear-cut, but it has been shown that in affected.........endotheliosis are too difficult to assess 
routinely 18.") is speculations, which should be kept to a minimum. 
I have problems with the expression "clear-cut" in the context were it is used. There may be a 
clear-cut line between the two groups, but it is more in accordance with the results to state that the unaffected have no excess of adverse outcomes such as SGA.. Do the authors mean decidual spiral arterial acute atherosis, which is not obvious for the average 
reader? 
Although atherotic desidual changes occur in many cases of early onset and serious preeclapsia 
and in IUGR, it is not a characteristic of mild and late onset preeclampsia. Therefore, the authors 
should be careful in their deductions with regard to decidual/placental pathology, which there is 
scarcely any direct basis for from their results. 
"In a similar vein of thought..": Is it really a similar vein of thought? Decidual atherotic changes or 
plaental dysfunction, and atherogenic metabolic features are not necessarily related. 
The 2nd paragraph begins with the statement that preeclampsia is heterogeneous, continuing with 
"Our results may be useful in counselling patients and their first-degree relatives." It is difficult to see 
how the sentences are logically connected. I think that first two sentences in the 2nd paragraph are 
superfluous. 
The last sentences of the 2nd paragraph: "Accordingly, the results may have implications in genetic 
linkage studies........." It seems that reference no 25 is meant only to serve as an example of such a 
genetic linkage study without supporting the results. This should be made clearer. 
I have problems understanding how the results have implications for genetic linkage studies. 
Stratifying woman into affected and not affected seems to me rather obvious and scarcely an 
original thought. I think that it is not a good idea to include this point in the paper, neither should be 
included in the title. The last sentence: "Another point .." is superfluous. 
Conclusions 
The Conclusions should be much briefer including main points only. 
References 
The references are still not quite consistently formatted, e.g. ref. no 1: "...65(5): 605-612." Compared 
with ref. no 3: "...23, 622-666." 
Tables 
The lines " RISK FACTOR" (Table 1), "CHARACTERISTICS" (Table2), and "OUTCOME" (Table 3) 
should have equal type size. 
Competing interests: 
None declared.