Fetal Echocardiography in Gestational Diabetes Mellitus

Background Gestational diabetes mellitus (GDM) is associated with significant maternal and fetal complications, including potential effects on fetal cardiac development. This study aimed to evaluate structural and functional cardiac changes in fetuses of mothers with GDM using fetal echocardiography and to compare them with those of healthy pregnancies. The primary objective of this study was to evaluate functional cardiac changes, specifically interventricular septum (IVS) thickness and posterior wall thickness, E/A ratio (ratio of early (E) to late (A) diastolic mitral inflow velocities), and fractional shortening, in fetuses of mothers with GDM. The secondary objective was to assess the presence of structural cardiac abnormalities. Methodology This was a comparative, cross-sectional study conducted over six months (January 2024 to July 2024) in the Department of Cardiology and Obstetrics at the Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. The study included 100 women with GDM and 100 with normal pregnancies as controls. Fetal echocardiography was performed between 24 and 28 weeks of gestation using two-dimensional and pulsed-wave Doppler sonography to evaluate structural and functional cardiac parameters. Specifically, measurements included IVS thickness, posterior wall thickness, the E/A ratio, and fractional shortening. These parameters were assessed in fetuses of mothers with GDM and compared with those from healthy pregnancies. Results Fetal echocardiographic assessment revealed significantly increased left ventricular posterior wall thickness and IVS thickness in both systole and diastole in the GDM group compared to controls (p < 0.001; 95% confidence interval (CI) = 0.55 to 0.85]. Additionally, the E/A ratio was significantly lower in the GDM group (p < 0.001; 95% CI = -0.06 to -0.01), indicating impaired diastolic function. Despite these changes, no congenital heart defects were identified in either group, as confirmed by postnatal echocardiography. Conclusions Fetuses of mothers with GDM exhibit notable structural and functional cardiac changes, including increased myocardial thickness and altered diastolic function. These findings emphasize the importance of fetal echocardiography in pregnancies complicated by GDM to identify early cardiac adaptations and guide clinical management. Further research is needed to explore the long-term cardiovascular implications of these findings.