Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - Results of a prospective observational study from South India

Abstract

Background: Diabetic pregnancies, particularly those complicated by gestational
diabetes mellitus (GDM) or pregestational diabetes, are associated with an increased
risk of adverse neonatal outcomes. Fetal echocardiography provides critical insights
into fetal cardiac structure and function, which may be altered due to chronic
intrauterine hyperglycemia.
Objective: To evaluate the predictive value of fetal echocardiographic findings at
term in diabetic pregnancies for identifying adverse neonatal outcomes in a South
Indian population.
Methods: This prospective observational study was conducted at a tertiary care
center in South India from January to December 2024. Pregnant women with
diabetes (GDM or pregestational) undergoing fetal echocardiography at 37–40 weeks
were enrolled. Echocardiographic parameters such as interventricular septal
thickness, cardiothoracic ratio, and diastolic function (E/A ratio) were measured.
Neonatal outcomes including birth weight, NICU admission, hypoglycemia,
respiratory distress, and Apgar scores were recorded. Associations between fetal
cardiac parameters and neonatal outcomes were statistically analyzed.
Results: Among 150 diabetic pregnancies, abnormal fetal echocardiographic findings
were observed in 44%. Interventricular septal hypertrophy and altered E/A ratio were
significantly associated with NICU admissions (p < 0.01), neonatal hypoglycemia (p
= 0.02), and respiratory distress (p = 0.03). Fetuses with cardiomegaly had a 3.1-fold
increased risk of composite adverse outcomes.
Conclusion: Fetal echocardiography at term in diabetic pregnancies serves as a
valuable, non-invasive predictor of adverse neonatal outcomes. Routine
echocardiographic screening may aid in perinatal risk stratification and improve
neonatal management strategies in high-risk diabetic pregnancies.