Reviewer ’s report  
 
Title: Number of Parity Is Associated with Low -Grade Albumin uria in Middle -Aged and Elderly 
Chinese Women  
 
Version: 1 Date: 09 Apr 2019  
 
Reviewer: Kirk P. Conrad  
 
Reviewer's report:  
 
Brief Summary  
 
In a community -based retrospective study of 6495 women >40 years of age, the authors present 
evidence for a significant association of low grade microalbuminuria and parity of  >2 children. 
This association persisted after correcting for multiple confounde rs (e.g., older age, SBP, TG, 
HDL -C, fasting glucose, eGFR). In further subgroup analysis after multiple adjustments, a 
significant relationship was observed between parity and low grade microalbuminuria for women 
> 55 years. On balance, this work is well -executed and compelling, the major conclusions being 
supported by the statistical analyses.  
 
 
Major Comments  
 
1. The authors excluded 451 subjects from the analysis with ACR>30 mg/g. Was there a 
trend for microalbuminuria to be associated with parity in thes e women?  
 
 
2. Although pregnancy recall is not great especially after so many years, do the authors have 
any information about the health of the pregnancies? Were these all normal obstetrical 
outcomes, i.e., without preterm labor, pregnancy hypertension, fetal growth  restriction, 
etc? Is there any reason to believe that abnormal obstetrical outcomes may have been 
over-represented in the multiparous women >2 pregnancies?  
 
 
Minor Comments  
 
1. By and large the English usage is good. But some editing for English usage by BM C 
Women's Health may be indicated.  
 
 
2. Background, lines 49 -52. Awkward. Please rephrase for clarity.  
 
 
3. Discussion, lines 209 -211. What are the mechanisms whereby high parity promotes 
weight gain, insulin resistance and dyslipidemia?  
Are the methods appropriate and well described?  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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 o f the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization th at 
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 reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the w ebsite along with the authors' 
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to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal