Title : Evaluation of fetal cardiac function in women affected by gestational diabetes mellitus compared to normal pregnancies
Abstract:
Gestational Diabetes Mellitus (GDM) is one of the most common pregnancy complications and is associated with significant maternal and neonatal morbidity. Beyond the well-established risk of foetal overgrowth, increasing evidence suggests that GDM may induce subtle cardiovascular alterations in utero. These subclinical changes are not routinely evaluated during standard prenatal care, yet they may contribute to adverse perinatal and long term cardiometabolic outcomes.
In this prospective cohort study, 53 pregnant women between 29+0 and 34+0 weeks of gestation were enrolled at Humanitas San Pio X in Milan, including 20 with GDM and 33 healthy controls. Foetal cardiac assessment focused on four ultrasound-based parameters: Modified Myocardial Performance Index (Mod- MPI), epicardial fat thickness (EFT), aortic intima-media thickness (IMT), and interventricular septal thickness. Subgroup analyses further evaluated differences between spontaneous and assisted reproductive conceptions, as well as between diet and insulin treated GDM cases.
Foetuses of mothers with GDM showed a trend toward higher Mod-MPI compared to controls, reaching statistical significance in spontaneously conceived pregnancies (p= 0.046). In three group analysis (controls, GDM diet, GDM insulin), overall differences in Mod-MPI were significant (p=0.022), with the highest values observed among diet-treated GDM cases. No significant intergroup differences were found in EFT, IMT or interventricular septal thickness.
These findings indicate that GDM, even in the absence of overt structural anomalies may be associated with subtle but measurable alterations in foetal cardiac function. Mod-MPI emerged as the most sensitive marker of dysfunction, supporting its uses as a non-invasive tool for risk stratification in GDM pregnancies. Incorporating targeted foetal cardiac assessment into third trimesters evaluation may help identify at risk foetuses and inform tailored clinic management strategies.
