Reviewer ’s report  
Title: Intrahepatic cholestasis of pregna ncy and associated cause s of death: a cohort study with 
follow -up of 27 -46 years  
 
Version: 2 Date: 31 Jan 2018  
 
Reviewer: Hanns -Ulrich Marschall  
 
Reviewer's report:  
The revised manuscript has substantially improved. All my major concerns have been addressed 
satisfactorily, with the exception of my second comment that was also raised by Reviewer 4 in 
his/her first comment, i.e. the uncommonly low laboratory criteria of ICP for serum 
transaminases and bile acids.  
 
I recommend to add the comments in the Letter to the Editor to the manuscript as follows:  
 
Methods: At least one of the following was required at that time at Tampere University Hospital: 
ASAT >35 U/l, ALAT >40 U/l, or bile acids 6 μmol/l or more.  
 
Also, a new sentence in Discussion needs revision:  
A wea kness of the study is that the levels of bile acids, levels of liver enzymes or total parity are 
not known.  
cannot be correct as then no inclusion based on serum levels of bile acids and/or transaminases 
would have possible.  
 
I recommend rephrasing A weakn ess of the study is that the levels of bile acids and/or 
transaminases used for diagnosis of ICP were somewhat lower than more recent criteria.  
 
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 am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscri pt: 
Acceptable  
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, fundi ng, or salary from an 
organisation that may in any way gain or 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 t hat may in any way gain or lose 
financially from t he 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 com peting 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 re ply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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I agree to the open peer review policy of the journal