# The impact of maternal gestational diabetes mellitus on cardiac structural and functional parameters in infants

## TL;DR

This study found that maternal gestational diabetes mellitus is linked to subtle heart structure changes in infants, especially in males, which could hint at future cardiovascular risks.

## Contribution

The study reveals sex-specific cardiac structural changes in infants exposed to gestational diabetes, suggesting potential long-term cardiovascular risks.

## Key findings

- GDM exposure was associated with increased cardiac dimensions in infants, particularly in males.
- Age-stratified analysis showed different effects in infants under 6 months versus 6–12 months.
- GDM increased odds of extremely high right atrial dimension in male infants.

## Abstract

This study aimed to retrospectively analyze changes in cardiac structural and functional parameters in infants born to mothers with nonpharmacologically managed gestational diabetes mellitus (GDM) to investigate potential cardiovascular developmental risks in GDM offspring beyond overt birth defects and to examine their age and sex specificity.

This retrospective cohort study included infants aged 1–12 months who underwent routine pediatric health examinations, including cardiac ultrasound screening, at Guangdong Women and Children Hospital from January 2018 to December 2023. Participants were assigned to a GDM group or a non-GDM control group based on maternal diagnosis. Echocardiography measured cardiac parameters. Multivariable linear and logistic regression models assessed the association between GDM exposure and cardiac parameters, with stratification by infant age (< 6 months vs. 6–12 months) and sex.

A total of 11,782 mother–infant pairs were enrolled (1,734 in the GDM group; 10,048 in the non-GDM group). After adjusting for confounders, GDM exposure was significantly associated with larger cardiac dimensions, including increased right atrial dimension (RAD) (adjusted mean difference [aMD] = 0.22, 95% confidence interval [95% CI]: 0.09–0.36, p = 0.001), right ventricular outflow tract dimension (aMD = 0.19, 95% CI: 0.08–0.30, p = 0.001), left atrial dimension (LAD) (aMD = 0.17, 95% CI: 0.03–0.32, p = 0.020), left ventricular end-diastolic dimension (aMD = 0.29, 95% CI: 0.11–0.46, p = 0.002), and left ventricular end-systolic dimension (aMD = 0.17, 95% CI: 0.05–0.29, p = 0.006). Age-stratified analysis revealed that in infants < 6 months, GDM was associated with increased RAD (aMD = 0.13, 95% CI: 0.01–0.26, p = 0.040) and LAD (aMD = 0.19, 95% CI: 0.04–0.33, p = 0.013). Conversely, in infants aged 6–12 months, GDM was associated with smaller right ventricular dimension (aMD = − 0.37, 95% CI: − 0.72 to − 0.01, p = 0.043) and LAD (aMD = − 0.48, 95% CI: − 0.79 to − 0.17, p = 0.002). Sex-stratified analysis showed that the associations between GDM and enlarged cardiac structures were significant only in male infants. Furthermore, GDM significantly increased the odds of extremely high RAD (≥ 95th percentile) in male infants (OR = 1.30, 95% CI: 1.02–1.65). No significant association was found between GDM and left ventricular ejection fraction in any model.

Maternal GDM induces subtle, sex-specific cardiac structural changes in infants, particularly in male infants. Although not clinically overt, these alterations may indicate long-term cardiovascular risk, highlighting the need for longitudinal follow-up and research to clarify their predictive value for future cardiovascular disease.