Association of fetal epicardial fat thickness with adverse perinatal outcomes and assessment of fetal cardiac function in fetal growth restriction

Objective This study investigates the association between fetal epicardial fat thickness (EFT) and adverse perinatal outcomes in pregnancies complicated by fetal growth restriction (FGR), and assesses changes in fetal cardiac function. Materials and Methods This single‐center, prospective observational study was conducted at a tertiary referral hospital. A total of 120 pregnancies between 28 and 37 weeks of gestation were enrolled: 40 with FGR and 80 healthy controls. EFT, fetal cardiac function parameters, and perinatal outcomes were compared between the FGR and control groups, and the same parameters were compared between the early‐onset and late‐onset FGR subgroups. Receiver operating characteristic analysis was used to evaluate the ability of EFT to discriminate composite adverse perinatal outcome (CAPO). Results Epicardial fat thickness was significantly lower in the FGR group than in controls ( P < 0.001). Among fetal cardiac function parameters, the modified myocardial performance index (Mod‐MPI) and isovolumetric relaxation time were significantly higher in the FGR group ( P = 0.002 and P = 0.001, respectively), whereas ejection time was significantly shorter ( P = 0.013). EFT was significantly lower in early‐onset than in late‐onset FGR ( P < 0.001). Mod‐MPI and isovolumetric contraction time were significantly higher in early‐onset FGR ( P < 0.05 for both). The rate of CAPO was higher in the FGR group ( P < 0.001). Conclusion In this cohort, reduced EFT was associated with FGR and with impaired fetal cardiac function. EFT is a simple, non‐invasive parameter that might help identify FGR pregnancies at increased risk of adverse perinatal outcomes; however, larger multicenter studies are needed to confirm these findings and to validate the proposed cut‐off value.