Assessment of fetal cardiac function at term in pregnancies complicated by diabetes

Hintergrund Children of diabetic pregnancies are at increased cardiovascular risk later in life. Research suggests that cardiac dysfunction may begin even before birth. Current studies assess fetal cardiac function during mid-pregnancy, with only a few including in the 3rd trimester and none at term. Therefore, the aim of this study was to assess fetal cardiac function at term in diabetic pregnancies, compared to healthy controls.

Methoden This prospective, cross-sectional, single-centre study was conducted at a tertiary referral hospital in Germany. The study included women with diabetes (dGDM, iGDM, DM Typ 1 & 2) and healthy controls, all without preeclampsia or fetal growth restriction at a gestational age of≥37+0 weeks. Fetal cardiac function was assessed using FetalHQ®​ software (GE Healthcare) and M-mode. P-values<0.05 were considered statistically significant. Ethical approval was obtained from our institutional review board ([Abb. 1]).

Abb. 1  

Ergebnisse 1) 4-chamber view analysis with FetalHQ 2) FetalHQ automatically measures ventricular changes during heart contraction, shown by a colour shift (light to dark blue) a) global longitudinal strain b) fractional area change c) basal-apical length fractional shortening d) tricuspid annular plane systolic excursion 3) interventricular septum thickness

Overall, 452 pregnancies were analysed, including 94 with diabetes and 358 controls. Cardiac function analysis revealed reduced contractility of both ventricles in fetuses from diabetic pregnancies, with alterations in systolic and diastolic function. Compared to controls, diabetic pregnancies exhibited significantly lower biventricular Global Longitudinal Strain (left: p<0.001, right: p=0.001), reduced left Ventricular Fractional Area Change (p=0.026), lower biventricular Basal Apical Length Fractional Shortening (left p=0,011, right p=0,06), and diminished Tricuspid Annular Plane Systolic Excursion (p=0.029). Furthermore, a significantly thicker interventricular septum was observed in the diabetic group (p=0.036). Cardiac function was comparable across diabetes types.

Schlussfolgerung This is the first large study to evaluate fetal cardiac function at term. Our results demonstrate functional impairment in fetuses of diabetic mothers after 37+0 weeks of gestation, supporting the potential value of future preventive cardiovascular strategies for these neonates.

 

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Publikationsverlauf

Artikel online veröffentlicht:
16. Oktober 2025