Fetal PR Interval in Pregnancies with Intrahepatic Cholestasis of Pregnancy: A Case–Control Study

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

• Differences in fetal cardiac function in patients with and without intrahepatic cholestasis.

• PR interval and bile acid levels in pregnant women with intrahepatic cholestasis.

• 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

Publication History

Received: 05 September 2022

Accepted: 26 September 2023

Accepted Manuscript online:
29 September 2023

Article published online:
21 November 2023

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