# Alteration in Fetal Cardiac Function at Mid-Gestation Among Pregnancies Subsequently Complicated by Preeclampsia, Fetal Growth Restriction and Gestational Diabetes Mellitus: A Literature Review

## TL;DR

This review explores how fetal heart function changes during mid-pregnancy in cases that later develop preeclampsia, fetal growth restriction, or gestational diabetes.

## Contribution

The study systematically reviews mid-gestation fetal cardiac deformation data using 2D-STE to identify early cardiovascular programming signatures.

## Key findings

- 2D-STE detects subclinical myocardial deformation before conventional methods in pregnancies with later complications.
- Mid-gestation (18–28 weeks) is a critical window for identifying early fetal cardiovascular changes.
- Current data on mid-gestation fetal cardiac function in high-risk pregnancies remain limited.

## Abstract

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.