Assessment of fetal cardiac function and epicardial fat thickness in intrahepatic cholestasis pregnancies

Abstract

Aims: This study is to evaluate fetal cardiac activity and epicardial fat thickness (EFT) in pregnant women with intrahepatic cholestasis (IHCP) and to investigate the relationship between these measurements and perinatal outcomes. Methods: This prospective case-control study was conducted between May 2022 and October 2024 at a tertiary perinatology clinic. The study group comprised 38 women with IHCP, and the control group included 39 healthy pregnancies matched for gestational age and maternal characteristics. Fetal cardiac function was evaluated by echocardiographic parameters including the Myocardial Performance Index (MPI), isovolumic contraction time (ICT), ejection time (ET), and PR interval, and EFT was quantified in the four-chamber view. Doppler indices of the umbilical, middle cerebral, and uterine arteries, along with neonatal outcomes such as gestational age, birth weight, APGAR scores, and neonatal intensive care unit (NICU) admission, were recorded. Results: In the IHCP cohort, bile acid, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were significantly elevated (p<0.001). MPI, ICT, ET, and PR interval values were also increased, indicating subclinical effects on fetal cardiac function. No significant differences were detected in EFT between groups. Gestational age at birth was lower in the IHCP group (p=0.005), and NICU admission was clinically higher, though not statistically significant. Conclusion: IHCP may impair fetal cardiac conduction and contractility, with these alterations positively associated with serum bile acid concentrations. EFT seems more closely linked to chronic metabolic stress than to acute conditions. Regular echocardiographic monitoring may aid in safeguarding fetal well-being.

Keywords

• Cholestasis
• intrahepatic
• fetal heart
• Myocardial Performance Index
• epicardial fat
• bile acids

İntrahepatik kolestazlı gebeliklerde fetal kardiyak fonksiyon ve epikardiyal yağ kalınlığının değerlendirilmesi

Abstract

Amaç: Bu çalışma, intrahepatik kolestaz (İHK) tanısı konulan gebelerde fetal kardiyak aktiviteyi ve epikardiyal yağ dokusu (EFT) kalınlığını değerlendirmeyi ve bu parametrelerin perinatal sonuçlarla olan ilişkisini araştırmayı amaçlamaktadır. Yöntem: Bu prospektif olgu-kontrol çalışması, Mayıs 2022 ile Ekim 2024 tarihleri arasında bir üçüncü basamak perinatoloji kliniğinde gerçekleştirilmiştir. Çalışma grubunu İHK tanısı konulan 38 gebe oluştururken, kontrol grubunu gestasyonel yaş ve maternal özellikler açısından eşleştirilmiş 39 sağlıklı gebe oluşturmuştur. Fetal kardiyak fonksiyon, ekokardiyografik parametrelerle (MPI, ICT, ET, PR aralığı) değerlendirilmiş ve EFT dört boşluk görüntüsünde ölçülmüştür. Umbilikal arter, orta serebral arter ve uterin arter Doppler indeksleri ile birlikte yenidoğan sonuçları (doğum haftası, doğum ağırlığı, APGAR skorları ve YDYB kabulü) kaydedilmiştir. Bulgular: İHK grubunda safra asidi, AST ve ALT düzeyleri anlamlı şekilde artmıştı (p<0.001). MPI, ICT, ET ve PR aralığı değerlerinde belirgin artış gözlenmiş olup, bu durum embriyonal kalp fonksiyonlarında subklinik etkilenmeyi düşündürmektedir. Gruplar arasında EFT düzeylerinde anlamlı bir fark saptanmamıştır. Doğum haftası İHK grubunda daha erken gerçekleşmiştir (p=0.005) ve yenidoğan yoğun bakım gereksinimi klinik olarak artmış olsa da istatistiksel olarak anlamlı bulunmamıştır. Sonuç: İHK, fetal kardiyak iletim ve kontraksiyon mekanizmaları üzerinde olumsuz etkilere yol açabilir. Bu değişiklikler, serum safra asidi düzeyleriyle pozitif ilişki göstermektedir. EFT, akut durumlardan çok kronik metabolik stresle ilişkili görünmektedir. Zamanında yapılan ekokardiyografik takip, fetal iyilik halinin korunmasında faydalı olabilir.

Keywords

• İntrahepatik Kolestaz
• Fetal Kalp
• Miyokardiyal Performans İndeksi
• Epikardiyal Yağ Dokusu
• Safra Asitleri

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