The impact of total bile acid levels on fetal cardiac function in intrahepatic cholestasis of pregnancy using fetal echocardiography: a tissue Doppler imaging study

J Matern Fetal Neonatal Med. 2016;29(9):1445-50. doi: 10.3109/14767058.2015.1051020. Epub 2015 Jun 11.


Aim: The aim of this study was to assess total bile acid (TBA) levels and its impact on systolic and diastolic functions in fetuses of mothers with intrahepatic cholestasis of pregnancy (ICP) using tissue Doppler imaging (TDI), and to explore the correlation between TBA levels and fetal cardiac function.

Subjects and methods: The study employed 98 pregnant women with ICP who were divided into two groups according to their bile acid levels. Fifty pregnant women without ICP represented the control group.

Results: Significant differences in the myocardial tissue velocities of both mitral and tricuspid valves were found between the fetuses of mothers with ICP and TBA levels of <40 mmol/L and the control group, versus fetuses of mothers with ICP and TBA levels >40 mmol/L. There was a significant increase in neonatal respiratory distress, meconium staining and neonatal TBAs in group II compared to the control group and group I. There was a correlation between maternal TBA levels and preterm delivery, APGAR scores and neonatal TBA levels at birth. There was also a positive correlation between maternal TBA and fetal myocardial tissue velocities of both mitral and tricuspid, and fetal diastolic myocardial tissue Doppler velocities.

Conclusion: ICP is a very serious condition especially when maternal TBA levels are >40 mmol/L. Fetal echocardiography with tissue Doppler is a useful tool for fetal assessment in patients with ICP. It could be an indication of induction of labor in cases of ICP and bile acid levels ≥40 mol/L. Neonatal echocardiography is mandatory for follow-up and management of these neonates.

Keywords: Fetal myocardial tissue Doppler; intrahepatic cholestasis of pregnancy; total bile acids.

MeSH terms

  • Adolescent
  • Adult
  • Bile Acids and Salts / blood*
  • Case-Control Studies
  • Cholestasis, Intrahepatic / blood
  • Cholestasis, Intrahepatic / diagnostic imaging
  • Cholestasis, Intrahepatic / physiopathology*
  • Diastole
  • Echocardiography, Doppler
  • Female
  • Fetal Heart / diagnostic imaging
  • Fetal Heart / physiopathology*
  • Humans
  • Pregnancy
  • Pregnancy Complications / blood
  • Pregnancy Complications / diagnostic imaging
  • Pregnancy Complications / physiopathology*
  • Systole
  • Young Adult


  • Bile Acids and Salts

Supplementary concepts

  • Intrahepatic Cholestasis of Pregnancy