Reviewer's report 
 Associations of depression and depressive symptoms with preeclampsia: Results from a Peruvian Title: 
case-control study 
 1  10 June 2007 Version: Date: 
 Vilho Hiilesmaa Reviewer: 
Reviewer's report: 
General 
This study is a useful addition to the limited literature concerning the association of depression and 
preeclampsia. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
1. The authors were able to collect a large number (N=339) of parturients with preeclampsia. 
-Can you classify the severity of the condition using suitable criteria, (e.g. RR over 160/100, proteinuria over 
3 g/24 h. etc)? 
-What was the number of cases with eclampsia? 
-Breakdown of preeclampsia should at least be included in the description of the material. 
2. Please give more information on the setting of the obstetric care in Lima: 
-How many deliveries per year were there in the two hospitals? 
-Are they tertiary care/university or regional hospitals? -Are the most difficult cases of preeclampsia treated in these two hospitals or are they referred to somewhere else? 
-How well the material represents all women with preeclampsia in the region? 
3. In Methods/paragraph 2/end you say that 95% of those who were approached agreed to participate. 
-Please provide, if possible, the total number of cases with preeclampsia in the hospitals. 
-How many % of them were approached by your team. How many patients with preeclampsia you did not 
approach? -Is there any selection bias of cases with more severe vs. less severe preeclampsia being included in your 
study. 
4. Table 1: 
-Please sub-classify Gestational age at delivery (as you did for BMI in the same Table) , e.g. number (%) of 
deliveries at <26, 26-28, 29-31, 32-34, 35-37, >37 weeks. 
-Use suitable cutpoints as you prefer. 
-Prematurity is the most important of perinatal problems and deserves attention in any study. 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
5. Classification of depression (pages 6; Table 2) : 
-To which category the score 20 belongs? Please clarify. -The score of exactly 20 is currently not allocated in no category. 
6. Methods, paragraph 2: 
-I dont get the significance of the sentence "Nulliparity was not a criterion for diagnosis in this investigation" -Please clarify of delete. 
7. I would prefer Standard Deviations (SD) instead of Standard Errors (SE) to describe the variation in a 
continuous variable. 
-SE (or SEM) gives the variation of the calculated mean, and is highly dependent 
on the sample size. 
-SD is better in that it gives to the reader an idea of the variation between the individuals (Table 1). 
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Discretionary Revisions (which the author can choose to ignore) 
8. It would be interesting to know whether there is a correlation between the degree of depression and 
severity of preeclampsia. 
9. As you say, the number of women with severe depression was very small. 
-Is there any reason to keep them as a separate group? 
-You could merge them into the moderate-severe group. 
-The term moderate-severe is a bit confusing and you could consider replacing it with another expression, such as considerable, major, etc. 
10. Table 3 is very large. 
-Its impact related to its space is small. -In my opinion, you could eliminate Table 3 and extend the text on page 8 as needed (last paragraph of Results describing the contents of the table. 
11. How about the number of Cesarean sections and deliveries with forceps/vacuum extractions? 
-Did you register the data? 
-These are important data to describe the material. They reflect obstetric practices in the hospitals. 
-Do cesareans and assisted vaginal deliveries have any impact on your results? 
 Accept after discretionary revisions What next?: 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests with regard to refereeing this article. 
Vilho Hiilesmaa, MD, PhD 
Associate Professor, senior perinatologist, 
Department of Obstetrics ang Gynecology 
Helsinki University Central Hospital