Fetal ventricular contractility and birth outcomes: a prospective cohort study

Preeclampsia, gestational diabetes mellitus (GDM), and fetal growth restriction (FGR) are maternal complications that affect intrauterine growth and cardiovascular adaptation of fetuses. This study aimed to determine whether early fetal cardiac function predicts birth weight, gestational age at delivery, and the occurrence of maternal and fetal complications.

In this prospective cohort, there were 101 singleton pregnancies that had been evaluated at 20-22 gestational weeks using detailed fetal echocardiography. Maternal age, body mass index (BMI) and pregnancy complications (preeclampsia, GDM, FGR) were documented. Fetal parameters of echocardiography were left and right ventricular size, systolic function parameters, stroke volume, and cardiac output. To find the predictors of birth weight, gestational age, and complications, multivariate linear regression was conducted.

In preeclamptic mothers, fetuses had smaller ventricular dimensions but maintained systolic function, and FGR fetuses had smaller areas of LV end-diastolic and RV end-systolic. GDM was not tied to a significant heart defect in the fetus or birth weight. Maternal age was not linked to any fetal cardiac or birth outcome. These structural alterations in preeclampsia and FGR suggest subclinical cardiac remodeling, detectable in mid-gestation, which may represent early biomarkers of adverse outcomes. Fetal cardiac parameters were not significant predictors of birth weight; however, maternal BMI was strongly associated with birth weight. (p<0.001).

Early remodelling without functional deficiency is indicated by subclinical structural cardiac variations in preeclampsia and FGR, which highlight the importance of targeted attention during high-risk pregnancy and the use of weight optimization strategies before pregnancy.