{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T23:12:32Z","timestamp":1760656352398,"version":"build-2065373602"},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"15","license":[{"start":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T00:00:00Z","timestamp":1742428800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>First, to explore differences in fetal cardiac function in patients with and without intrahepatic cholestasis of pregnancy (ICP) based on the TEI index. Second, to explore a potential correlation between TEI index and bile acid levels in pregnant women with ICP. Third, to study changes in the TEI index of fetuses from pregnant women with ICP after administration of ursodeoxycholic acid (UDCA).<\/jats:p><jats:p>This is a prospective observational case-control study conducted at Hospital Cl\u00ednico San Jos\u00e9 and Cl\u00ednica RedSalud Vitacura, both in Santiago, Chile, between April 2018 and October 2020. ICP was defined as palmar-plantar pruritus of nocturnal predominance for more than 1 week associated with a total bile acid level above 10 \u03bcmol\/L. Control cases were women with pregnancies scheduled for induction or elective cesarean section between 37 and 40 weeks of gestation according to current protocols. Differences in the TEI index between cases and controls were assessed by the Wilcoxon test. The correlation between the TEI index and bile acid levels was assessed by the Spearman correlation test. Changes in TEI index before and after administration of UDCA were analyzed by the paired samples Wilcoxon test.<\/jats:p><jats:p>A total of 181 pregnant women were included in the study, 109 women with ICP and 72 controls. The median gestational age at inclusion was 35.9 weeks (interquartile range [IQR], 33.0\u201338.9). The median TEI index was 0.31 (IQR, 0.29\u20130.36); this was significantly longer in fetuses of women with ICP ([0.34, IQR, 0.30\u20130.38] vs. [0.30, IQR, 0.28\u20130.31], p\u2009&lt;\u20090.001). There was a significant correlation between bile acid levels and TEI index (0.584, p\u2009&lt;\u20090.001). In 21 fetuses, the TEI index was measured a second time, 2 weeks later, following UDCA administration. The median TEI index decreased significantly following UDCA administration (0.40\u2009ms before treatment [IQR, 0.36\u20130.42] vs. 0.33 after treatment [IQR, 0.32\u20130.38], p\u2009=\u20090.001), p\u2009=\u20090.001).<\/jats:p><jats:p>The TEI index is increased in fetuses of women with ICP. TEI index was significantly correlated with bile acid levels, and administration of UDCA significantly reduced the TEI index.<\/jats:p>","DOI":"10.1055\/a-2555-3684","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T20:53:15Z","timestamp":1742503995000},"page":"2032-2037","source":"Crossref","is-referenced-by-count":1,"title":["Fetal TEI Index in Pregnancies with Intrahepatic Cholestasis of Pregnancy: A Case-Control Study"],"prefix":"10.1055","volume":"42","author":[{"given":"Manuel","family":"Guerra","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Cl\u00ednico San Jos\u00e9, Santiago, Chile"},{"name":"Departament of Perinatology, Cl\u00ednica Redsalud Vitacura. Santiago, Chile"},{"name":"Escola de Doctorat, Universitat Aut\u00f2noma de Barcelona, Bellaterra, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Teresa","family":"Haye","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Cl\u00ednico San Jos\u00e9, Santiago, Chile"},{"name":"Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cl\u00ednica Alemana. Santiago, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio","family":"Monta\u00f1o","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Cl\u00ednico San Jos\u00e9, Santiago, Chile"},{"name":"Department of Ultrasonography, Cl\u00ednica Indisa. Santiago, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Toro","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Cl\u00ednico San Jos\u00e9, Santiago, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nerea","family":"Maiz","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/BF00177718","article-title":"Effects of bile acids on ventricular muscle contraction and electrophysiological properties: studies in rat papillary muscle and isolated ventricular myocytes","volume":"335","author":"O Binah","year":"1987","journal-title":"Naunyn Schmiedebergs Arch Pharmacol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1042\/cs1030191","article-title":"Taurocholate induces changes in rat cardiomyocyte contraction and calcium dynamics","volume":"103","author":"J Gorelik","year":"2002","journal-title":"Clin Sci (Lond)"},{"issue":"03","key":"ref3","first-page":"188","article-title":"[Influence of total bile acid in maternal serum and cord blood on neonatal cardiac function from intrahepatic cholestasis of pregnancy]","volume":"44","author":"L J Zhang","year":"2009","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"ref4","volume-title":"Gu\u00eda Perinatal de Chile","author":"A Germain","year":"2015","edition":"1st ed."},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/uog.11","article-title":"Fetal cardiac function assessed by Doppler myocardial performance index (Tei index)","volume":"21","author":"D Friedman","year":"2003","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1002\/uog.14769","article-title":"Monitoring intrahepatic cholestasis of pregnancy using the fetal myocardial performance index: a cohort study","volume":"46","author":"A Henry","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.7863\/ultra.33.7.1171","article-title":"Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy","volume":"33","author":"X Fan","year":"2014","journal-title":"J Ultrasound Med"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.3109\/14767058.2015.1051020","article-title":"The impact of total bile acid levels on fetal cardiac function in intrahepatic cholestasis of pregnancy using fetal echocardiography: a tissue Doppler imaging study","volume":"29","author":"W M Ataalla","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"07","key":"ref9","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1111\/jog.15283","article-title":"Fetal cardiac dysfunction in pregnancies affected by intrahepatic cholestasis of pregnancy: a cohort study","volume":"48","author":"M Rodriguez","year":"2022","journal-title":"J Obstet Gynaecol Res"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/S0140-6736(18)31877-4","article-title":"Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses","volume":"393","author":"C Ovadia","year":"2019","journal-title":"Lancet"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"e2964","DOI":"10.1055\/a-2184-0242","article-title":"Fetal PR interval in pregnancies with intrahepatic cholestasis of pregnancy: a case-control study","volume":"41","author":"M Guerra","year":"2024","journal-title":"Am J Perinatol"}],"container-title":["American Journal of 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