Fetal Cardiac Morphology Research Articles

Fetal Cardiac Function and Remodeling in In Vitro Fertilization Pregnancies: A Tertiary Center Experience.

To investigate fetal cardiac functions and remodeling in pregnancies conceived via in vitro fertilization (IVF). This prospective case-control study included 40 singleton IVF pregnancies and 46 uncomplicated control pregnancies at 28-36weeks of gestation. The IVF group consisted of pregnancies applied to the outpatient clinic, excluding those with anatomical or chromosomal abnormalities. Fetal cardiac morphological measurements, left myocardial performance index (MPI), cardiac output, spectral, tissue Doppler, and M-mode measurements were recorded. Ventricular and great vessel size were assessed for fetal cardiac morphology, while MPI, spectral Doppler, and tissue Doppler parameters were assessed for cardiac function. The right atrial area was statistically increased and the right ventricular basal sphericity index was statistically decreased in the IVF group. The mitral and aortic valves were smaller in the IVF group, while tricuspid and pulmonary valve measurements were similar. Left ventricular ejection time was statistically lower in the IVF group, although the MPI was similar. The IVF group had a higher right fetal MPI on tissue Doppler imaging, but the difference was not statistically significant. This study suggests that IVF pregnancies may demonstrate some effects of fetal cardiac remodeling and mild systolic dysfunction.

Clinical Application of the Fetal HQ Technique in the Evaluation of Normal Fetal Cardiac Function at Different Gestational Weeks.

To investigate the clinical value of fetal heart quantification (fetal HQ) in the evaluation of normal fetal heart size, morphology, and cardiac function at different gestational weeks. A total of 101 pregnant women diagnosed with a healthy fetus by fetal echocardiography from September 2021 to December 2023 were selected and classified into four different periods of gestational weeks: 20-28 weeks (25 cases), 29-32 weeks (26 cases), 33-36 weeks (26 cases), and 37-40 weeks (24 cases). Quantitative analyses were performed by automatically tracking the endocardium using fetal HQ software that comes with the Voluson E10 from GE. To investigate the correlation between four-chambered vesicle length end-diastolic (4CV LED), four-chambered vesicle transverse width end-diastolic (4CV TWED), global sphericity index (GSI), ejection fraction (EF), stroke volume (SV), cardiac output (CO), and gestation age (GA), and the variability of normal fetal cardiac morphology and cardiac function at different gestational weeks. A statistically significant difference was observed between 4CV LED and 4CV TWED in normal fetuses at different gestational weeks (p < 0.05), which exhibited a positive correlation with gestational week. Conversely, no significant correlation was identified between GSI and gestational week (p > 0.05). The mean GSI of 101 normal fetuses was found to be 1.25±0.09. A comparative analysis of EF, SV, and CO in normal fetuses at different gestational weeks revealed statistically significant differences in SV and CO (p < 0.05), which gradually increased with gestational weeks, whereas there was no statistically significant difference in EF (p > 0.05). Fetal HQ represents a straightforward and dependable method for evaluating GSI and 24-segment SI of the left and right ventricles, which can provide a certain theoretical basis for the clinical quantitative evaluation of fetal cardiac geometry and cardiac function.

Effects of Gestational Diabetes Mellitus on Fetal Cardiac Morphology.

This study aims to investigate the possible effects of gestational diabetes mellitus (GDM) on fetal heart structure and the relationship of this effect with maternal blood sugar control. In this cross-sectional study, 19 women with GDM at 24-36 weeks of gestation (case group) and 21 healthy pregnant women at the same weeks of gestation (control group) were examined. Fetal heart structure was evaluated by ultrasonography; interventricular septum (IVS) thickness, right and left ventricular sphericity indices, global sphericity index (GSI) and cardio-thoracic ratio were also measured. In addition, mothers' HbA1c values (an indicator of blood sugar control) were recorded. An increase in IVS thickness was observed in the fetuses of mothers with GDM. A more rounded trend was observed in the right ventricular structure, but this did not create a significant difference. No significant relationship was found between maternal blood sugar control and fetal heart structure. This study examined the effects of gestational diabetes on fetal cardiac morphology and the relationship of this effect with maternal glycemic control. Babies of mothers with GDM had a significantly thicker interventricular septum. A more rounded trend was detected in the right ventricular structure. However, this change was not found to be statistically significant. In addition, no significant correlation was found between maternal glycemic control and fetal cardiac morphology.

Quantitative analysis of fetal cardiac structure and function in gestational diabetes mellitus using fetal HQ technology

BackgroundGestational diabetes mellitus (GDM) can contribute to changes in fetal cardiac structure and function, with potential implications for long-term cardiovascular health. This study focuses on assessing these cardiac adaptations in fetuses from GDM pregnancies by using the innovative Fetal Heart Quantification (Fetal HQ) technology to provide a detailed evaluation of structural and functional parameters. MethodsA prospective study was conducted from March 2023 to October 2024 at Xiangyang No.1 People's Hospital, involving 382 pregnant women in their second and third trimesters, including 167 with GDM and 215 healthy controls. Fetal cardiac assessments were performed using Fetal HQ, which allows for direct measurement of cardiac deformation and function. Key parameters such as left ventricular (LV) and right ventricular (RV) dimensions, global longitudinal strain (GLS), and fractional area change (FAC) were analyzed. Maternal clinical data, including blood glucose levels and body mass index (BMI), were also collected. Statistical analyses were performed to compare the cardiac parameters between the two groups. ResultsSignificant differences were observed in fetal cardiac dimensions, with the GDM group exhibiting larger LV end-diastolic area (2.04 ± 0.73 cm2 vs. 1.81 ± 0.69 cm2, p = 0.002) and lower RV GLS (−20.1 ± 5.3 % vs. -22.6 ± 4.6 %, p = 0.000). Other functional parameters, including LV GLS and FAC, did not show significant differences between groups. Correlation analysis revealed a significant positive relationship between maternal HbA1c levels and RV FAC (r = 0.348, p = 0.036), indicating that maternal glycemic control may influence fetal cardiac function. ConclusionsThe findings suggest that GDM is associated with altered fetal cardiac morphology, particularly in the left ventricle, and impaired right ventricular function, as evidenced by reduced GLS. These results highlight the potential impact of maternal hyperglycemia on fetal cardiac development and underscore the importance of monitoring fetal cardiac health in pregnancies complicated by GDM. The use of Fetal HQ technology provides a valuable tool for early detection of cardiac dysfunction in this high-risk population.

Evaluation of fetal cardiac morphology and function by fetal heart quantification technique in the normal second and third trimesters.

The study of fetal heart is receiving increasing attention. Fetal heart quantification (Fetal HQ) technology is a new speckle tracking technology that can analyze the 24-segment morphology and function of fetal ventricles. This study aims to use Fetal HQ to assess the changes in the structure and function of the fetal heart in normal mid to late pregnancy, providing a foundation for the clinical application of fetal cardiac speckle tracking technology. The heart size, global sphericity index (GSI), left ventricular [stroke volume (SV)], cardiac output (CO), ejection fraction (EF), global longitudinal strain (GLS), fractional area change (FAC), 24-segment end-diastolic diameter (EDD), sphericity index (SI) and fractional shortening (FS) of the two ventricles of 500 normal pregnant fetuses were evaluated by Fetal HQ. The subjects were divided into 5 groups according to gestational weeks (GA), and the changes of fetal heart morphology and function were observed. P<0.05 indicated the statistically significant difference. The fetal heart rate decreased gradually with the increase of GA (P<0.05). The size parameters of the fetal heart and two ventricles gradually increased with increasing GA (P<0.05). The 24 segments EDD of both ventricles increased with increasing GA (P<0.05), while the EDD increased first and then decreased from the ventricle base to the apex. The GSI and the 24 segments SI of two ventricles were basically not significantly different among the groups (P>0.05). The EF, GLS, FAC of the left ventricle and the GLS, FAC of the right ventricle decreased with the increase of GA (P<0.05), and SV and CO increased with increasing GA (P<0.05). The 24 segments FS of the left ventricle showed a downward trend with the increase of GA and gradually increased from the base to the apex. The FS of most segments of the right ventricle decreased with the increase of the GA and increased first and then decreased from the base to the apex. The whole and segmental size parameters of fetal heart can quantitatively evaluate the growth and development of fetal heart; the GSI and segmental SI are reliable morphological indexes for evaluating fetal heart; fetal ventricular function parameters EF, FAC, GLS and segmental FS can evaluate fetal cardiac function. The Fetal HQ technique can help us to evaluate the heart growth and development of normal fetuses in the second and third trimester of pregnancy.

Glucose control during pregnancy in patients with type 1 diabetes correlates with fetal hemodynamics: a prospective longitudinal study

BackgroundMaternal diabetes adversely affects fetal cardiovascular system development. Previous studies have reported that the fetuses of mothers with diabetes exhibit both structural and functional changes; nevertheless, prior studies have not examined the association between glucose control and fetal cardiac morphology and performance. Thus, the objective was to determine the association between fetal cardiac morphology and function and maternal glucose control in type 1 diabetes and to compare the differences in measured cardiac parameters between the fetuses of mothers with diabetes and healthy controls.MethodsIn this prospective, longitudinal case-control study — including 62 pregnant women with type 1 diabetes mellitus and 30 healthy pregnant women — fetal cardiac assessment using B-mode, M-mode, and spectral pulsed-wave Doppler was performed in the second and third trimesters. In women with T1DM, glycated hemoglobin and data obtained from glucose sensors — including the percentage of time in, below, and above the range (TIR, TBR, and TAR, respectively), and coefficient of variation (CV) — were analyzed across three time periods: the last menstrual period to 13 (V1), 14–22 (V2), and 23–32 weeks (V3) of gestation. Fetal cardiac indices were compared between groups, and the correlation between glucose control and fetal cardiac indices was assessed.ResultsAt 28–32 weeks, the fetuses of women with T1DM exhibited increased left ventricular end-diastolic length, relative interventricular septum thickness, right ventricular cardiac output, and pulmonary valve peak systolic velocity compared with healthy controls. At 18–22 weeks, pulmonary and aortic valve diameters, left and right ventricular stroke volumes, and left cardiac output inversely correlated with the CV and glycated hemoglobin levels at V1 and V2. Furthermore, at 28–32 weeks, pulmonary and aortic valve diameters, left ventricular stroke volume, cardiac output, and right/left atrioventricular valve ratio inversely correlated with the TBR at V1, V2, and V3. Moreover, diastolic functional parameters correlated with the TAR and glycated hemoglobin levels, particularly after the first trimester.ConclusionIn women with T1DM, maternal hyperglycemia during pregnancy correlates with fetal diastolic function, whereas glucose variability and hypoglycemia inversely correlate with fetal left ventricular systolic function in the second and third trimesters.

Post-COVID-19 Fetal Cardiac Morphology and Systolic Evaluation in Infected Pregnant Women by Fetal Heart Quantification Technology.

Due to the government's liberalization of epidemic control, the current 2019 novel coronavirus disease (COVID-19) has started to spread widely within China. This study aimed to use the fetal heart quantification (fetal HQ) technique to assess the cardiac function and morphology of the fetuses of pregnant women diagnosed with COVID-19 in the early stages of pregnancy. Exactly 86 pregnant women diagnosed with COVID-19 infection in early pregnancy (COVID-19 group) and 90 healthy pregnant women (control group) who underwent fetal echocardiography were prospectively included in this study. The fetal HQ technique was applied to compare the differences in the global sphericity index (GSI), global strain values (GS), fractional area change (FAC), and 24-segment fractional shortening (FS) of the left and right ventricles, between the COVID-19 group and the control group. Compared with the control group, the differences in GS and 24-segment FS of the left ventricle in the COVID-19 group were not statistically significant. However, the COVID-19 group showed lower GSI values compared with the control group (1.24 vs 1.28). FAC (48.12%) of the left ventricle and GS (-23.55%), FAC (41.74%) of the right ventricle in the COVID-19 group were reduced compared with FAC (50.50%) of the left ventricle and GS (-27.63%), FAC (46.01%) of the right ventricle in the control group. Segmental analysis revealed reduced FS in segments 20-24 in the COVID-19 group compared with the control group. Right ventricular GS was an independent predictor of adverse pregnancy outcome with an optimal cutoff value of -18.66%. The results suggest that COVID-19 infection in early pregnancy may have a negative impact on fetal cardiac morphology and function. Fetal HQ may offer a new assessment method for the early identification of fetal cardiac alterations in pregnant women infected with COVID-19.

Subclinical cardiac impairments in fetuses conceived through assisted reproductive technology by speckle tracking echocardiography.

To evaluate the changes of cardiac morphology and function in fetuses conceived through assisted reproductive technologies (ART) by speckle tracking echocardiography. A retrospective study was conducted in 101 spontaneously conceived (SC) fetuses and 99 ART-conceived ones. Fetal echocardiography was performed, fetal cardiac morphology and function were analyzed using two-dimensional speckle tracking software, including global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC) of the left and right ventricles, as well as segmental sphericity index (SI), end-diastolic diameter (ED), and fractional shortening (FS) in 24 segments. Compared to the SC fetuses, the ART-conceived fetuses exhibited decreased GSI (median [interquartile range], 1.22 [1.16-1.27] vs. 1.18 [1.11-1.24], p=0.007), decreased right ventricular GLS (24.9 [21.5-27.6] vs. 23.2 [20.4-26.8], p=0.026), and decreased right ventricular FAC (mean±standard deviation, 39.7±6.4 vs. 37.2±7.1, p=0.003). Analysis of the 24 segments showed that ART-conceived fetuses had reduced SI in the apical segments of right ventricle and increased ED in several segments of the right ventricle. Fetuses conceived through ART had a more spherical shape of the global heart and predominantly right-sided cardiac remodeling and systolic function impairment.

Changes in the shape and function of the fetal heart of pre- and gestational diabetes mothers

BackgroundHyperglycemia during pregnancy can affect fetal heart in many ways, including causing cardiac malformation, leading to hypertrophic cardiomyopathy and cardiac dysfunction. Echocardiographic evaluation can assist identify alterations in heart structure, morphology and function, enabling prompt monitoring and management. However, according to earlier research, the cardiac alterations are modest in hyperglycemic mothers’ fetuses, and might not be detectable using conventional methods and it is also unclear whether these changes are related to the metabolism of mothers. Fetal Heart Quantification (Fetal HQ) can assess ventricular geometry and function more sensitively and thoroughly, and identify sub-clinical cardiac dysfunction. The purpose of this study was to evaluate fetal heart by Fetal HQ in fetuses of hyperglycemic mothers who either had pre-gestational or gestational diabetes and to correlate them with maternal metabolic indices.MethodsThe fetuses of 25 gestational age-matched control mothers, 48 women with gestational diabetes mellitus (GDM), and 11 women with diabetes mellitus (DM) were included in the prospective case-control research. Using fetal echocardiography and speckle tracking echocardiography (STE), the heart of the fetus was evaluated. Differences in the groups’ anthropometric, metabolic, and cardiac parameters were examined. It was assessed whether maternal features, prenatal glucose, lipids, and maternal hemoglobin A1c (HbA1c) correlated with fetal cardiac parameters.ResultsThe LV EDV and ESV were significantly higher in the GDM group as compared to the DM group (p < 0.05). The GSI% was significantly lower in the GDM group compared with the control (p < 0.05). The LV SV and CO of the GDM group were both significantly higher compared with the DM group (p < 0.05). There was a significant decrease in RV FS for segments 1–7 in GDM fetuses compared to the control (p < 0.05) and for segments 5–10 compared to DM (p < 0.05). Fetal cardiac morphology and function indices correlate with maternal pregestational weight, BMI, early pregnancy fast glucose, lipids, and glycemic control levels.ConclusionsFetuses exposed to gestational diabetes have altered heart morphology and function that is linked to maternal metabolic parameters, which presents a special indication for performing geometry and function cardiac assessment. Fetal HQ can be employed to evaluate the fetal cardiac shape and function in fetuses exposed to gestational diabetes.

Fetal Cardiac Function at Midgestation and Subsequent Development of Preeclampsia

To assess differences in cardiac morphology and function at midgestation in fetuses from pregnancies that subsequently developed preeclampsia (PE) or gestational hypertension (GH). This was a prospective study in 5,801 women with singleton pregnancies attending for a routine ultrasound examination at midgestation, including 179 (3.1%) who subsequently developed PE and 149 (2.6%) who developed GH. Conventional and more advanced echocardiographic modalities, such as speckle-tracking, were used to assess fetal cardiac function in the right and left ventricle. The morphology of the fetal heart was assessed by calculating the right and left sphericity index. In fetuses from the PE group (vs the no PE or GH group) there was a significantly higher left ventricular global longitudinal strain and lower left ventricular ejection fraction that could not be accounted for by fetal size. All other indices of fetal cardiac morphology and function were comparable between groups. There was no significant correlation between fetal cardiac indices and uterine artery pulsatility index multiple of the median or placental growth factor multiple of the median. At midgestation, fetuses of mothers at risk of developing PE, but not those at risk of GH, have mild reduction in left ventricular myocardial function. Although absolute differences were minimal and most likely not clinically relevant, these may suggest an early programming effect on left ventricular contractility in fetuses of mothers who develop PE.

Fetal Cardiac Function at Midgestation in Women Who Subsequently Develop Gestational Diabetes

Fetuses in women with gestational diabetes (GD) compared with those without GD show evidence of subclinical cardiac functional and morphological changes. However, it is uncertain whether glycemia or the adverse maternal underlying risk factor profile is the main driver for fetal cardiac remodeling. To assess cardiac morphology and function at midgestation in fetuses of mothers prior to development of GD and compare them with those of unaffected controls. During this prospective nonintervention screening study at 19 to 23 weeks' gestation, fetal cardiac morphology and function were assessed in all participants. Pregnancy complications were obtained from the medical records of the women. Fetal cardiac morphology and function were assessed in all participants at Harris Birthright Research Institute at King's College Hospital, London, United Kingdom. Participants included pregnant women with singleton pregnancy who attended their routine fetal ultrasound examination at midgestation and agreed to participate in the Advanced Cardiovascular Imaging Study in pregnancy. Comparison of fetal cardiac morphology and function between mothers who subsequently developed GD and those who did not develop GD. This was a prospective nonintervention screening study of 5620 women with singleton pregnancies at 19 to 23 weeks' gestation. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricle. The morphology of the fetal heart was assessed by calculating the right and left sphericity index. The 5620 included patients had a mean age of 33.6 years. In 470 cases, the women were diagnosed with GD after the midgestation echocardiographic assessment (8.4%). Women with GD, compared with the non-GD group, were older, had higher BMI, higher prevalence of family history of diabetes, non-White ethnicity, chronic hypertension, and GD in a previous pregnancy. In fetuses of the GD group compared with the non-GD group, there was mild increase in interventricular millimeter thickness (0.04; 95% CI, 0.03-0.06 mm) and left atrial area (0.04; 95% CI, 0.04-0.05), whereas left and right functional indices were comparable between groups with the exception of left ventricular ejection fraction, which was marginally improved in the GD group (0.02; 95% CI, 0.03-0.03). This study demonstrates that prior to development of GD, there was mild alteration in fetal cardiac morphology without affecting cardiac function. This suggests that the adverse maternal risk factor profile and not only the glycemia might contribute to cardiac remodeling noted in fetuses of women with GD.

Assessment of fetal cardiac morphology and functional changes in early-onset and late-onset fetal growth restriction.

To compare the fetal cardiac morphology and functions of early-onset fetal growth restriction (EO-FGR) and late-onset fetal growth restriction (LO-FGR) groups with gestational weeks-matched controls. A total of 164 pregnant women were included, 28 of whom were in the EO-FGR group, 54 in the LO-FGR group, and 82 in the control group. Fetal echocardiographic evaluation was performed with two-dimensional, M-mode, tissue Doppler imaging (TDI), and pulsed wave Doppler. Fetal cardiac morphologic measurements and diastolic and systolic functions changed in EO-FGR and LO-FGR fetuses compared with controls. The EO- and LO-FGR fetuses had reduced right and left cardiac output, increased myocardial performance index, and significantly higher mitral and tricuspid E/E' ratios compared with controls. The EO-FGR fetuses had lower mitral and tricuspid E and E' values. In LO-FGR fetuses, mitral and tricuspid E' values were lower than in their controls (P= 0.001 and P< 0.001). On the other hand, the mitral and tricuspid E values were not significantly changed (P= 0.107 and P= 0.196). We hypothesized that EO-FGR and LO-FGR fetuses had insufficient myocardial maturation. Especially in the LO-FGR fetuses, TDI is the earliest and most sensitive technique to show subtle changes in fetal cardiac functions.

Evaluating fetal heart morphology in hypertensive disorders of pregnancy using the fetal heart quantitative technique.

This study sought to explore the clinical application value of fetal heart quantification (HQ) technology in the evaluation of fetal heart morphology in hypertensive disorders of pregnancy (HDP). Fetal HQ software was used to quantitatively analyze the 4-chamber global sphericity index (GSI) and 24-segment sphericity index (SI) and Z scores of 53 normal fetal hearts (the normal group) and 26 fetal hearts with gestational hypertension (the case group). The normal Z value range was set at -2 to 2. There was a statistically significant difference between the 1-16 and 20-24 segments of the left and right ventricles in the normal group (P<0.05), but there was no statistically significant difference between the 17-19 segments (P>0.05). There was no statistically significant difference in the fetal GSI between the 2 groups (P>0.05). There was no statistically significant difference in the SI of the 24 segments of the fetal left ventricle between the 2 groups (P>0.05). There was no statistically significant difference in the SI between the 1-20 segments of the right ventricle between the 2 groups (P>0.05), but there was a statistically significant difference in the SI between the 21-24 segments (P<0.05). There was no statistically significant difference in the incorrect ratio of the Z value of the GSI between the 2 groups (P>0.05). There was no statistically significant difference in the abnormal rate of the Z value of the SI in each segment of the fetal left ventricle between the 2 groups (P>0.05). There was a significant difference in the abnormal rate of the Z value of the SI in each segment of the fetal right ventricle between the 2 groups (P<0.05). Fetal HQ technology can be used in the quantitative analysis of cardiac morphology in gestational hypertension, and provides a new method for fetal cardiac morphology analysis.

The heart in congenital diaphragmatic hernia: Knowns, unknowns, and future priorities

There is growing recognition that the heart is a key contributor to the pathophysiology of congenital diaphragmatic hernia (CDH), in conjunction with developmental abnormalities of the lung and pulmonary vasculature. Investigations to date have demonstrated altered fetal cardiac morphology, notably relative hypoplasia of the fetal left heart, as well as early postnatal right and left ventricular dysfunction which appears to be independently associated with adverse outcomes. However, many more unknowns remain, not least an understanding of the genetic and cellular basis for cardiac dysplasia and dysfunction in CDH, the relationship between fetal, postnatal and long-term cardiac function, and the impact on other parts of the body especially the developing brain. Consensus on how to measure and classify cardiac function and pulmonary hypertension in CDH is also required, potentially using both non-invasive imaging and biomarkers. This may allow routine assessment of the relative contribution of cardiac dysfunction to individual patient pathophysiological phenotype and enable better, individualized therapeutic strategies incorporating targeted use of fetal therapies, cardiac pharmacotherapies, and extra-corporeal membrane oxygenation (ECMO). Collaborative, multi-model approaches are now required to explore these unknowns and fully appreciate the role of the heart in CDH.

A preliminary study on fetal cardiac morphology and systolic function of normal and anemic pregnant women by fetal heart quantification technology.

BackgroundMaternal anemia is a common nutritional problem during pregnancy. Fetal heart quantification (fetal HQ) technology is used to quantitatively evaluate the size, shape, and contractile function of the fetal heart, which can reflect the development of the fetus in the uterus.MethodsWe used fetal HQ technology to evaluate the basal-apical length (BAL), the transverse width (TW) and the area (A) of the four chamber view at end-diastole in 77 normal fetuses and 40 fetuses of women with anemia. We analyzed the changes of fetal heart size and measured the global sphericity index (GSI), the fraction area change (FAC), and the global longitudinal strain (GLS). The sphericity index (SI) and the fractional shortening (FS) of 24 segments were analyzed to identify any changes of fetal heart morphology and systolic function. The normal range of Z value was set at −2 to 2.ResultsFetal BAL, TW, A, and gestational age (GA) were positively linearly correlated, while GSI, GLS, and FAC had no significant correlation with GA. There was no significant difference in fetal BAL, TW, A, GLS, and FAC between the two groups (P>0.05). There was no significant difference in the FS of the 24 segments of the left and right ventricles between the two groups (P>0.05). There was no significant difference in the SI of the 1-24 segments of the right ventricle between the two groups (P>0.05). The difference in fetal GSI between the two groups was statistically significant (P<0.05). There was no significant difference in SI between the 1–22 segments of the left ventricle between the two groups (P>0.05), but there was a statistically significant difference between the 23–24 segments (P<0.05).ConclusionsThe fetal HQ analysis technology can quickly and simply quantitatively assess the size, shape, and contractility of the fetal heart. Anemia in pregnant women has no significant effect on fetal heart size and systolic function; it only affects the morphology of the heart, showing that the heart tends to be spherical as a whole and some segments of the apical segment of the left ventricle are abnormal.

Evaluation of fetal cardiac morphology and functions in pregnant women with familial Mediterranean fever.

We aimed to evaluate and compare fetal cardiac morphology and functions of pregnant women with familial Mediterranean fever (FMF) and healthy pregnant women. The study included 34 pregnant women with FMF and 68 healthy pregnant women matched with maternal age, gravidity, parity, gestational age, and pre-pregnancy body mass index (BMI) in 34th-37th gestational weeks. Fetal echocardiographic evaluation was performed with two-dimensional (2D) imaging, M-mode imaging, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI). Fetal cardiac morphological measures, including cardiothoracic ratio, cardiac axis angle, right and left ventricular area, sphericity index, and ventricular septal thickness was similar in both groups. Compared with the control group, myocardial performance index (MPI), which indicates global myocardial performance, was significantly higher, and ejection time (ET) was significantly shortened in the FMF group. In addition, which shows the diastolic functional parameters such as, tricuspid E wave, E/A, E/E' ratio, and mitral E wave, E/A, E/E' ratio, were significantly higher; tricuspid A and mitral A waves were significantly lower. We found that mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) were significantly lower in those with FMF duration over eight years than those with FMF duration less than 8 years. There is no fetal cardiac morphological change in pregnant women with FMF. However, there may be changes in diastolic function. As the maternal FMF duration increases, systolic functions may also change.

Fetal cardiac morphology and geometry in pregnancies with class A1 and A2 gestational diabetes mellitus

Objective To evaluate whether certain parameters on fetal cardiac morphology and geometry measured at 20–22 weeks of gestation differ in subsequently diagnosed gestational diabetes mellitus (GDM) pregnancies and whether these changes are associated with disease severity as indicated by class A1 and A2 GDM. Method It was designed as a retrospective study. All measurements were taken between 20 and 22 weeks of gestation. We compared fetal cardiac structural measurements of 200 uncomplicated pregnancies (control group) with those of 307 GDM patients (160 of the them were regulated with diet (GDM A1) and 147 of them received insulin treatment (GDM A2) during pregnancy). GDM were diagnosed between 24-28 weeks of gestation with 75 gram (g) oral glucose tolerance test. Results The interventricular septum (IVS) was thicker in both in GDM A2 and GDM A1 than control (p < .001, p < .001), and there was statistically significant difference between GDM A2 and GDM A1 (p = .012). In both left and right wall thickness in GDM A1 and GDM A2 were remarkably higher than control group (p < .001, p < .001, p < .001, p < .001). The left and right spherical indices were higher in both GDM A1 and GDM A2 groups than controls (p = .021 and p = .028). Left and right area in GDM A1 and GDM A2 groups were significantly smaller than control groups (p < .001 and p = .001). Conclusion Gestational diabetes is a common obstetric morbidity, which causes fetal cardiac structural changes. Our study shows that these changes can occur during the early weeks of pregnancy.

Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study

BackgroundDue to metabolic changes in the second trimester and the increasing number of pregnant women with obesity and advanced maternal age, the incidence of gestational diabetes mellitus (GDM) remains high. This study aimed to evaluate the effects of GDM on fetal cardiac morphology and function, and to determine whether these changes increase with increasing estimated fetal weight (EFW).MethodsFifty-eight women with GDM (GDM group) and 58 women with a healthy pregnancy (control group) were included in this prospective observational cohort study. Each group included subgroups of 31 pregnant women with a gestational age between 24+0 weeks and 27+6 weeks as well as 27 pregnant women with a gestational age between 28+0 weeks and 40+0 weeks. For all fetuses, a cine of 2–3 s in the four-chamber view was obtained, and online speckle-tracking analysis was performed using the GE Automatic Fetal Heart Assessment Tool (fetal HQ; General Electric Healthcare Ultrasound, Zipf, Austria) to measure the global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), 24-segment sphericity index (SI), and 24-segment end-diastolic diameter of the left ventricle (LV) and right ventricle (RV). Data were analyzed using the independent t-test and Wilcoxon rank-sum test, as applicable.ResultsThe GDM group (mean HbA1c value was 5.3 ± 0.57 mmol/L) showed a lower GSI value than the control group (1.21 vs. 1.27, P = 0.000), which indicated a rounder shape of the heart. In addition, fetuses in the GDM group demonstrated significant impairment in cardiac function compared to those in the control group (LV-GLS: -18.26% vs. -22.70%, RV-GLS: -18.52% vs. -22.74%, LV-FAC: 35.30% vs. 42.36%, RV-FAC: 30.89% vs. 36.80%; P = 0.000 for all). Subgroup analyses according to gestational age (24+0–27+6 weeks and 28+0–40+0 weeks) showed that the statistical differences were retained between the GDM and control groups in each subgroup.ConclusionsFetuses of women with GDM present with signs of biventricular systolic dysfunction according to deformation analysis using fetal HQ. Additionally, the heart had a rounder shape in the GDM group than in the control group. This study showed that fetal HQ can be used to assess fetal cardiac morphology and function easily and quickly, and the effects of GDM on fetal cardiac morphology and function appeared from the second trimester. Thus, whether earlier and stricter clinical intervention was necessary remained to be further studied. Furthermore, future studies will need to supplement the effects of blood glucose levels on GLS, FAC, GSI, and 24-segment SI. Additionally, the long-term follow-up after birth should also be improved to observe the influence of changes in the indicators on the prognosis.

Fetal cardiac function at 35-37 weeks' gestation in pregnancies that subsequently develop pre-eclampsia.

To compare fetal cardiac morphology and function between pregnancies that subsequently developed pre-eclampsia (PE) and those that remained normotensive. This was a prospective observational study in 1574 pregnancies at 35-37 weeks' gestation, including 76 that subsequently developed PE. We carried out comprehensive assessment of fetal cardiac morphology and function including novel imaging modalities, such as speckle-tracking echocardiography, and measured uterine artery pulsatility index, mean arterial pressure (MAP), serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and cerebroplacental ratio (CPR). The findings in the group that subsequently developed PE were compared to those in pregnancies that remained normotensive. In fetuses of mothers who subsequently developed PE, compared to those from normotensive pregnancies, there was a more globular right ventricle, as shown by reduced right ventricular sphericity index, reduced right ventricular systolic contractility, as shown by reduced global longitudinal strain, and reduced left ventricular diastolic function, as shown by increased E/A ratio. On multivariable regression analysis, these indices demonstrated an association with PE, independent of maternal characteristics and fetal size. In pregnancies that subsequently developed PE, compared to those that remained normotensive, MAP, sFlt-1 and the incidence of low birth weight were higher, whereas serum PlGF, CPR and the interval between assessment and delivery were lower. These findings demonstrate that, in pregnancies that develop PE, there is evidence of impaired placentation, reflected in low PlGF and reduced birth weight, placental ischemia, evidenced by increased sFlt-1 which becomes apparent in the interval of 2-4 weeks preceding the clinical onset of PE, and consequent fetal hypoxia-induced redistribution in the fetal circulation, reflected in the low CPR. Although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop PE remains unclear, it is possible that the reduction in right-heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia-induced redistribution in the fetal circulation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Influence of birth weight on fetal cardiac indices at 35–37 weeks' gestation

Echocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation. This was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy-induced hypertension or pre-eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA-PI by UA-PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters. The study population included 146 (9.7%) small-for-gestational-age (SGA) fetuses with birth weight < 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non-SGA and non-FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth-weight Z-score. There were no significant associations between cardiac morphological and functional indices and UtA-PI Z-score or CPR Z-score. This screening study at 35-37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphology and function but UtA-PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.