The impact of maternal gestational diabetes mellitus on cardiac structural and functional parameters in infants

This study aimed to retrospectively analyze changes in cardiac structural and functional parameters in infants born to mothers with nonpharmacologically managed gestational diabetes mellitus (GDM) to investigate potential cardiovascular developmental risks in GDM offspring beyond overt birth defects and to examine their age and sex specificity.

This retrospective cohort study included infants aged 1-12 months who underwent routine pediatric health examinations, including cardiac ultrasound screening, at Guangdong Women and Children Hospital from January 2018 to December 2023. Participants were assigned to a GDM group or a non-GDM control group based on maternal diagnosis. Echocardiography measured cardiac parameters. Multivariable linear and logistic regression models assessed the association between GDM exposure and cardiac parameters, with stratification by infant age (< 6 months vs. 6-12 months) and sex.

A total of 11,782 mother-infant pairs were enrolled (1,734 in the GDM group; 10,048 in the non-GDM group). After adjusting for confounders, GDM exposure was significantly associated with larger cardiac dimensions, including increased right atrial dimension (RAD) (adjusted mean difference [aMD] = 0.22, 95% confidence interval [95% CI]: 0.09-0.36, p = 0.001), right ventricular outflow tract dimension (aMD = 0.19, 95% CI: 0.08-0.30, p = 0.001), left atrial dimension (LAD) (aMD = 0.17, 95% CI: 0.03-0.32, p = 0.020), left ventricular end-diastolic dimension (aMD = 0.29, 95% CI: 0.11-0.46, p = 0.002), and left ventricular end-systolic dimension (aMD = 0.17, 95% CI: 0.05-0.29, p = 0.006). Age-stratified analysis revealed that in infants < 6 months, GDM was associated with increased RAD (aMD = 0.13, 95% CI: 0.01-0.26, p = 0.040) and LAD (aMD = 0.19, 95% CI: 0.04-0.33, p = 0.013). Conversely, in infants aged 6-12 months, GDM was associated with smaller right ventricular dimension (aMD = - 0.37, 95% CI: - 0.72 to - 0.01, p = 0.043) and LAD (aMD = - 0.48, 95% CI: - 0.79 to - 0.17, p = 0.002). Sex-stratified analysis showed that the associations between GDM and enlarged cardiac structures were significant only in male infants. Furthermore, GDM significantly increased the odds of extremely high RAD (≥ 95th percentile) in male infants (OR = 1.30, 95% CI: 1.02-1.65). No significant association was found between GDM and left ventricular ejection fraction in any model.

Maternal GDM induces subtle, sex-specific cardiac structural changes in infants, particularly in male infants. Although not clinically overt, these alterations may indicate long-term cardiovascular risk, highlighting the need for longitudinal follow-up and research to clarify their predictive value for future cardiovascular disease.