Title: The impact of intrahepatic cholestasis on pregnancy outcomes: a retrospective cohort
study
Version: 3 Date: 26 Aug 2022
Reviewer's report:
This was a retrospective cohort study of women with and without ICP in Hangzhou, China.
One of this study's strengths is the volume of patients included in the analysis with over 650
subjects analyzed.  With this large cohort a number of interesting observations were made
including a difference in mode of delivery between the cohorts as well as increase incidence of
hyperlipidemia between groups.
One of the issues with the study is the framing of the conclusion of HepB being an adverse
pregnancy outcome for subjects with ICP.  This is not really the correct conclusion in my mind.
It should be that subjects with ICP were more likely to have chronic or carrier status for HepB.
I dont think this should be described as an adverse pregnancy outcome, as it is part of the patient
demographics, not something that occurred because of, or isolated to during the pregnancy.
In review of Table 1, patient demographics, please double check some of the calculations
indicating statistical significance.  Some of the mean values are every close to each other, but
the p values are extremely low.  For example height and BMI are almost exactly the same with
extremely similar ranges, so I find it surprising that these were  as significant as reported.
The pregnancy complications and pregnancy outcomes section is very hard to read, so perhaps
consider re-wording.  The last few sentences of this section dont really make sense to me and
probably require more narrative.
Please double check the manuscript for grammatic and spelling errors.  There are several
throughout.
Title: The impact of intrahepatic cholestasis on pregnancy outcomes: a retrospective cohort
study
Version: 3 Date: 26 Aug 2022
Reviewer's report:
This was a retrospective cohort study of women with and without ICP in Hangzhou, China.
One of this study's strengths is the volume of patients included in the analysis with over 650
subjects analyzed.  With this large cohort a number of interesting observations were made
including a difference in mode of delivery between the cohorts as well as increase incidence of
hyperlipidemia between groups.
One of the issues with the study is the framing of the conclusion of HepB being an adverse
pregnancy outcome for subjects with ICP.  This is not really the correct conclusion in my mind.
It should be that subjects with ICP were more likely to have chronic or carrier status for HepB.
I dont think this should be described as an adverse pregnancy outcome, as it is part of the patient
demographics, not something that occurred because of, or isolated to during the pregnancy.
In review of Table 1, patient demographics, please double check some of the calculations
indicating statistical significance.  Some of the mean values are every close to each other, but
the p values are extremely low.  For example height and BMI are almost exactly the same with
extremely similar ranges, so I find it surprising that these were  as significant as reported.
The pregnancy complications and pregnancy outcomes section is very hard to read, so perhaps
consider re-wording.  The last few sentences of this section dont really make sense to me and
probably require more narrative.
Please double check the manuscript for grammatic and spelling errors.  There are several
throughout.
Please review this paper.
user
Title: The impact of intrahepatic cholestasis on pregnancy outcomes: a retrospective cohort
study
Version: 3 Date: 26 Aug 2022
Reviewer's report:
This was a retrospective cohort study of women with and without ICP in Hangzhou, China.
One of this study's strengths is the volume of patients included in the analysis with over 650
subjects analyzed.  With this large cohort a number of interesting observations were made
including a difference in mode of delivery between the cohorts as well as increase incidence of
hyperlipidemia between groups.
One of the issues with the study is the framing of the conclusion of HepB being an adverse
pregnancy outcome for subjects with ICP.  This is not really the correct conclusion in my mind.
It should be that subjects with ICP were more likely to have chronic or carrier status for HepB.
I dont think this should be described as an adverse pregnancy outcome, as it is part of the patient
demographics, not something that occurred because of, or isolated to during the pregnancy.
In review of Table 1, patient demographics, please double check some of the calculations
indicating statistical significance.  Some of the mean values are every close to each other, but
the p values are extremely low.  For example height and BMI are almost exactly the same with
extremely similar ranges, so I find it surprising that these were  as significant as reported.
The pregnancy complications and pregnancy outcomes section is very hard to read, so perhaps
consider re-wording.  The last few sentences of this section dont really make sense to me and
probably require more narrative.
Please double check the manuscript for grammatic and spelling errors.  There are several
throughout.
assistant