[Usefulness of routine fetal echocardiography in pregnancies with pre-existing maternal diabetes]

The primary objective of this study was to assess the contribution of fetal echocardiography in a population of women with pre-gestational diabetes to the detection of severe fetal heart disease. The secondary objective was to analyse the prevalence of heart disease according to periconceptional HbA1c levels.

Observational, single-centre, retrospective study conducted over ten years (2014-2024), including all pregnancies complicated by pre-gestational diabetes monitored in a type III maternity unit. The type of diabetes, periconceptional HbA1c, ultrasound data and perinatal outcomes were collected. Severe congenital heart disease was confirmed postnatally and defined by the need for neonatal surgical intervention.

A total of 331 women corresponding to 428 pregnancies were included. All underwent fetal echocardiography by a paediatric cardiologist. The overall prevalence of congenital heart disease was 4.4% (19/428), including 1.5% of severe forms (6/428). All severe heart defects were detected during screening ultrasound. Among women, 6.9% with a periconceptional HbA1c ≥10% had severe heart disease.

Systematic fetal echocardiography by a paediatric cardiologist does not appear to offer any additional benefit for the sensitivity of primary screening for severe diabetes-related heart disease. Echocardiography should be reserved for the precise characterisation of heart disease if it is detected during screening and diagnostic ultrasound and/or in cases of uncontrolled diabetes.