Title: Psychological Status of Pregnant Women During the Omicron Pandemic Outbreak in
China
Version: 4 Date: 11 Sep 2023
Reviewer's report:
The present study is considered to be an important study that clarifies the mental and
psychological state of pregnant women during an outbreak of Omicron strain infection in China.
Please consider adding or correcting the following points.
1. For ethical reasons, it would be better not to list the names of the research institutions
(Materials and methods Recruitment/ Table 4).
2.  If each site has its own characteristics, please describe them.
3. Please include the ethical review approval number.
4. Please cite all publications that have tested the reliability and validity of the GAD-7, PHQ-9
and ISI in China; for the GAD-7 and PHQ-9 there are publications with different cut-off values.
GAD-7: Validation of the 7-item Generalized Anxiety Disorder scale (GAD-7) as a screening
tool for anxiety among pregnant Chinese women(Yiqian Gong 2021)
PHQ-9#Reliability and validity of the Chinese version of the Patient Health Questionnaire
(PHQ-9) in the general population (Wenzheng Wang 2014#
5. The cut-off is set at three levels, but I believe the analysis uses two levels. Please provide
details on how you will use them in this study in your methodology.
6. A multiple logistic regression analysis was performed with the desire to have an abortion as
the dependent variable. Therefore, please include the desire to have an abortion in the statistical
analysis section.
7. As multiple testing was performed, please correct according to the Bonferroni method.
8. Please describe how the independent variables to be included in the weight logistic regression
analysis were determined.
9. As the two study facilities are unique in the two institutions, Table 1 should be reported for
each institution. And it would be easier to understand if you could provide the overall average
and other information in writing.
10. As there are 31 abortion requests, dividing by 10 gives 3, so the independent variables in the
logistic regression analysis should be up to 3 variables. It is therefore questionable whether the
results of the logistic regression analysis on abortion are reliable. Please report the effect size.
11. Regarding the third sub-question of the results, since there is no mention of caesarean section
in Tables 3 and 4, why not delete [caesarean section]?
12.There is little mention of results for caesarean section, so why not delete [caesarean section]
at the end of the first paragraph of the discussion?
13. The reference to during the COVID-19 pandemic should be changed to during the Omicron
strain epidemic.
14. The second paragraph states that the health status of pregnant women during a COVID-19
pandemic is generally poor, but a comparison is needed because it is not possible to assess
this without comparison with pregnant women in normal times. Similarly, abortions need to be
compared with normal conditions.
15. As for caesarean sections, a comparison with normal times is made, but it would be better
to discuss the reasons why no significant differences were found.
16. In paragraph 6 reference is made to a sudden association with place of residence. As this is
not mentioned in the results, it needs to be added.
17. The need for virtual maternity care mentioned in the second half of the seventh paragraph is
a leap from the results and should not be included in the conclusions.