Abstract
Objective This study had three purposes: first, to explore differences in fetal cardiac function
in patients with and without intrahepatic cholestasis of pregnancy (ICP) based on
PR interval (the interval between the beginning of the atrial contraction and the
beginning of the ventricular contraction). Second, to explore a potential correlation
between PR interval and bile acid levels in pregnant women with ICP. Third, to study
changes in PR interval of fetuses from pregnant women with ICP after administration
of ursodeoxycholic acid (UDCA).
Study Design This was a prospective observational case–control study. ICP was defined as palmar
plantar pruritus of nocturnal predominance for more than 1 week associated with a
total bile acid level >10 μmol/L. Control cases were women with pregnancies scheduled
for induction or elective cesarean section at term.
Results One hundred and ten women with ICP and 72 controls were included in the study. Median
gestational age at inclusion was 35.9 weeks. Median PR interval was significantly
longer in fetuses of women with ICP (122 vs. 102 ms, p < 0.001). There was a significant correlation between bile acid levels and PR interval
(rho = 0.723, p < 0.001). In 22 fetuses, the median PR interval decreased significantly following
UDCA administration (134 vs. 118 ms, p = 0.004).
Conclusion PR interval is longer in fetuses of women with ICP. PR interval was significantly
correlated with bile acid levels, and administration of UDCA significantly reduced
PR interval.
Key Points
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Differences in fetal cardiac function in patients with and without intrahepatic cholestasis.
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PR interval and bile acid levels in pregnant women with intrahepatic cholestasis.
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Changes in PR interval of fetuses from pregnant women with ICP after use of UDCA.
Keywords
PR interval - intrahepatic cholestasis of pregnancy - bile acid - ursodeoxycholic
acid - transaminitis
