Key result
Mid-gestation fetal myocardial function remains largely preserved before onset of preeclampsia, GDM, or FGR.
Why the study?
Data on fetal cardiac deformation parameters assessed by 2D-STE at mid-gestation, a critical preclinical window before the development of PE, FGR, or GDM, remain extremely limited.
Does 2D speckle-tracking echocardiography detect subclinical fetal cardiac dysfunction at mid-gestation in pregnancies that subsequently develop preeclampsia, fetal growth restriction, or gestational diabetes mellitus?
Systematic Review
Does 2D speckle-tracking echocardiography detect subclinical fetal cardiac dysfunction at mid-gestation in pregnancies that subsequently develop preeclampsia, fetal growth restriction, or gestational diabetes mellitus?
Fetal cardiac function remains largely preserved at mid-gestation in pregnancies destined for preeclampsia or GDM, suggesting that 2D-STE should currently be regarded as a marker of early adaptation rather than a standalone clinical predictive tool.
2D-STE should not yet serve as a clinical predictive tool; leaves open whether subtle alterations forecast later preeclampsia, GDM, or FGR.
Preeclampsia (PE), fetal growth restriction (FGR), and gestational diabetes mellitus (GDM) complicate approximately 15–20% of pregnancies and represent major contributors to perinatal morbidity, mortality, and long-term cardiovascular risk in offspring. Increasing evidence from longitudinal cohort studies indicates that adult cardiovascular disease, including hypertension, coronary artery disease, and stroke, may be programmed in utero through early alterations in fetal cardiac structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) has emerged as the most sensitive non-invasive technique for detecting subclinical myocardial deformation, often preceding abnormalities detected by conventional Doppler or biometric parameters. While numerous third-trimester studies have demonstrated impaired global longitudinal strain (GLS), altered ventricular geometry, and diastolic dysfunction in established disease, data from mid-gestation (18–28 weeks), the critical preclinical window, remain extremely limited. Therefore, this review aims to systematically synthesize the available evidence on fetal cardiac deformation parameters assessed by 2D-STE at mid-gestation in pregnancies that subsequently developed PE, FGR, or GDM, in order to identify the earliest detectable signatures of fetal cardiovascular programming and highlight key knowledge gaps that must be addressed prior to clinical implementation.
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Huluță et al. (2026) conducted a systematic review in Pregnancies subsequently complicated by preeclampsia (PE), fetal growth restriction (FGR), or gestational diabetes mellitus (GDM). Subsequent development of preeclampsia, fetal growth restriction, or gestational diabetes mellitus vs. Uncomplicated singleton pregnancies was evaluated on Indices of fetal systolic and diastolic myocardial function (e.g., global longitudinal strain, strain rate) at mid-gestation. Fetal myocardial function at mid-gestation remains largely preserved in pregnancies that subsequently develop preeclampsia, gestational diabetes mellitus, or fetal growth restriction, with 2D-STE detecting only subtle, subclinical alterations.
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