The problem of uncertain adherence to study interventions: what can we conclude?

Abstract

Intrahepatic cholestasis of pregnancy (ICP), the most common liver disease in pregnancy, is characterised by elevated bile acid concentrations and maternal pruritus, and has been associated with increased rates of stillbirth, preterm birth, and neonatal unit admission. Fetal complications have been associated with rising serum bile acids (Glantz et al, Hepatology 2004;40:467- 474) and, according to a recent individual patient data meta-analysis (Ovadia et al, The Lancet 2019;393:899-909), the risk of stillbirth increased in women with serum bile acid concentrations of 100 μmol/l or more.