Reviewer ’s report  
 
Title: Do self -reported pregnancy complications add to risk evaluation in older women with 
established cardiovascular disease?  
 
Version: 0 Date: 30 Jul 2019  
 
Reviewer: Jennifer Tabler  
 
Reviewer's report:  
 
Review: In women with established cardiovascular disease, do self -reported pregnancy 
complications ad d to risk evaluation?  
 
Summary  
* Overall, an interesting application of other literature, and an important research question 
(can we use past pregnancy as an indicator of cardiovascular risk?)  
* I cannot evaluate the medical assessment strategies for MSAD  or establishing cohorts, as 
I am not a clinician.  
* Tables need to be edited for clarity (Tables should be standalone from the text)  
 
Review  
* Small sample of women without CVD should be highlighted more in the limitations —
they do mention small sample siz e, but the non CVD sample is a huge limitation.  
* The premise of the paper is built on null or non -findings, but non -findings is much more 
likely with a small sample size! It is problematic to conclude that previous pregnancy issues 
provide no additional v alue—rephrase to "may not".  Make sure to moderate suggestions to "may 
not" "could not" "might not" rather than use such definitive language throughout.  
* A p-value of 0.06 is borderline significant, not significant —yet is presented as such in the 
abstrac t. 
 
Methodology  
* Limitations  
o Self-report of fertility complications —this is a huge issue given that the time frame for 
the self -report is so wide. Asking women about something happening up to 20 years ago, is 
problematic. You address this in the limitat ions, but should also emphasize that future studies 
should try to include longitudinal medical histories (non self -report). (Even if something is the 
"common" way of doing something, doesn't mean it's the way it should be done).  
o Other covariates (control s) are excluded, highlight the exclusion of education and income 
which are known to be associated with CVD in your limitations OR include them in your models 
if you have them (you do mention lack of some controls broadly, but be specific).  (examples of 
papers looking at education/income and cardiovascular disease: Degano et al., 2017 
10.1038/s41598 -017-10775 -3; Khaing et al., 2017 10.1177/2047487317705916)  
 
Tables  
* Table 1 is potentially unnecessary — you should describe response rate in -text. You 
already show the process for sample selection in Figure 1. You are presenting too much in Table 
1, limit it to describing your analytic sample in Table 1 (the sample you are actually looking at 
N=307).  
* Table 2 is messy/hard to read —it isn't clear what is or is n ot a categorical variable, the 
swinging sample size (n) is needlessly complicated (ns listed for each individual variable) —I 
suggest listwise deletion on key covariates, since this will be what's presented in multivariate 
logistic regression models anyway.   
o Please restructure and clean up your table 2. Also, please footnote analytic strategy to 
assess differences between CVD and non -CVD samples (independent t -tests, chi -squared, 
whatever it is) in the Table.  
* Table 3 is not standalone. You cannot interp ret the Table without going to the body of the 
manuscript. What results are even being presented? Logistic regression? Correlations? Reader 
should know this looking at Table 3.  
* Logistic regression results are not presented in a Table? Make sure to refer ence Tables in -
text more frequently, so the reader knows what Tables they should look at. It seems like not all 
the results are actually presented in Tables. You can say (not shown) if you do not create a Table 
(but standard practice is to present all resu lts in a Table format).  
 
* Grammar, please read through carefully and fix small grammatical errors present in the 
manuscript. Here are some examples:  
o Typo in the figure legend for REBUS  
o Run on sentence on lines 40 -45 (When describing the cohorts)  
o MSAD "is" defined, not "were" defined (it's singular) lines 27 -30. 
Are the methods appropriate and well d escribed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusion s drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 o r lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. 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?  
 
5. Do you have any other financial competing interests?  
 
6. 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 r eply is yes to any, please give details below.  
 
no competing interests  
 
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