The impact of gestational diabetes mellitus on mid-pregnancy and infant cardiac morphology and function: A prospective cohort study

Objective To evaluate the effects of gestational diabetes mellitus on cardiac morphology and function in fetuses during mid-pregnancy and in infants during the postnatal period. Methods This prospective cohort study included 64 pregnant women diagnosed with gestational diabetes mellitus allocated to the experimental group and 119 healthy pregnant women allocated to the control group. Fetal echocardiography was performed between 24 and 28 weeks of gestation, and the infants underwent echocardiography at approximately 42 days after birth. Maternal baseline characteristics, mid-pregnancy fetal echocardiographic data, and infant cardiac functional assessments were recorded and analyzed. Results Gestational age at the time of examination did not differ significantly between the control and gestational diabetes mellitus groups ( p > 0.05). Compared with controls, in fetuses of mothers with gestational diabetes mellitus, the thickness of the left ventricular wall and interventricular septum was increased, whereas the right ventricular ejection fraction was significantly reduced ( p < 0.05). In the gestational diabetes mellitus group, the fetal transvalvular early diastolic velocity to myocardial early diastolic velocity ratio of the tricuspid valve increased (as measured using echocardiography), whereas the tricuspid annular plane systolic excursion was lower than that in the control group ( p < 0.05). Compared with the control group, during infancy, the gestational diabetes mellitus group had a higher left ventricular transvalvular early diastolic velocity to myocardial early diastolic velocity ratio and lower tricuspid annular plane systolic excursion ( p < 0.05). Subgroup analysis of the gestational diabetes mellitus cohort showed no significant differences in fetal and neonatal echocardiographic parameters between the diet-controlled and insulin-treated subgroups. Conclusions Gestational diabetes mellitus is associated with alterations in fetal cardiac structure and function as well as persistent cardiac changes in infancy compared with the control group.