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IntroductionGestational diabetes mellitus (GDM) is a state of glucose intolerance with onset during pregnancy. GDM carries prenatal and perinatal risks as well as long-term risks for the mother and her child. GDM may be involved in the foetal programming of long-term cardiovascular health. However, evidence is sparse and the effect of GDM on cardiovascular health is unknown. To address these issues, we will conduct MySweetHeart Cohort study. The objectives are to assess the effect of GDM on offspring’s cardiovascular health early in life by using surrogate markers of cardiovascular disease and atherosclerosis.Methods and analysisThis is a cohort study of 100 offspring of women with GDM and 100 offspring of women without GDM. At inclusion, a baseline assessment of the mothers will be conducted through means of self-report questionnaires, a researcher-administrated interview, blood pressure and anthropometric measurements, and a maternal blood sampling. Between the 30th and 34th weeks of gestation, a foetal echography will be performed to assess the foetal cardiac structure and function, the fetomaternal circulation and the hepatic volume. At birth, maternal and neonatal characteristics will be assessed. An echocardiography will be performed to assess cardiac structure and function 2–7 days after birth; carotid intima-media thickness will be also measured to assess vascular structure. MySweetHeart Cohort is linked to MySweetHeart Trial (clinicaltrials.gov/ct2/show/NCT02890693), a randomised controlled trial assessing the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention to improve the cardiometabolic and mental health of women with GDM and their offspring. A long-term follow-up of children is planned.Ethics and disseminationEthical approval has been obtained through the state Human Research Ethics Committee of the Canton de Vaud (study number 2016–00745). We aim to disseminate the findings through regional, national and international conferences and through peer-reviewed journals.Trial registration numberClinicalTrials.gov (clinicaltrials.gov/ct2/show/NCT02872974).

The capacity to forecast nonreassuring fetal heart (NFH) is essential for minimizing perinatal complications; therefore, this research aims to establish if a machine learning (ML) model can predict NFH. This was a retrospective analysis of information gathered from singleton cases over the gestational age of 28 weeks that sought vaginal delivery between January 2020 and January 2022. The information was acquired from the “Iranian Maternal and Neonatal Network.“A predictive model was built using four statistical ML models (decision tree classification, random forest classification, extreme gradient boost classification, and permutation feature classification with k-nearest neighbors). Because of the limited studies on the identification of NFH predictors, we decided to use the Chi-Square test to compare demographic, obstetric, maternal, and neonatal factors to identify NFH predictors. Then, all variables with p -values less than 0.05 were considered potential NFH predictors. The area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F1 score were measured to evaluate their diagnostic performance. The incidence of NFH in our study population was 9.2%. Based on our findings NFH was more common in cases of intrauterine growth restriction, late-term, post-term, and preterm births, preeclampsia, placenta abruption, primiparous, induced labor, male fetus, and lower in birth with the presence of doula support. Random forest classification (AUROC: 0.77), decision tree classification and extreme gradient boost classification (AUROC: 0.76), and permutation feature classification with K-nearest neighbors (AUROC: 0.77), all showed good performance in predicting NFH. The higher performance belonged to random forest classification with an accuracy of 0.77 and precision of 0.72. Although this study found that the classification tree models performed well in predicting NFH, more research is needed to make a better conclusion on the performance of ML models in predicting NFH.

Background Fetal growth restriction (FGR) contributes to over 30% of late-pregnancy stillbirth, yet its diagnosis is challenging because current methods rely on indirect surrogate markers (estimated fetal weight and umbilical artery) that often fail to detect fetal compromise, particularly in late-onset cases. We hypothesized that fetal cardiac remodeling could provide a more robust basis for prediction. This study aimed to develop and validate the cardiac remodeling for FGR prediction model (CR-FGR), a first-in-class machine learning approach designed to operationalize the concept of fetal cardiac remodeling as a direct marker for FGR prediction. Methods This multicenter study of singleton pregnancies included retrospective development ( n  = 663) and prospective validation in two independent cohorts (internal, n  = 224; external, n  = 51). The primary outcome was FGR (birth weight < 10th percentile). From 938 echocardiography videos, 222 cardiac parameters were extracted. A machine learning process selected the five most predictive parameters for the final logistic regression model (CR-FGR): right ventricular stroke volume/kg (RVSV/kg), cardiac output/kg (RVCO/kg), cardiac output (RVCO), left ventricular cardiac output (LVCO), and end-systolic area (RVESA). Results The CR-FGR model showed robust performance, with an area under the curve (AUC) of 0.872 (95% confidence interval (CI), 0.780–0.935) in the prospective internal testing set and 0.831 (95% CI, 0.674–0.947) in the external testing set. Its performance was comparable to a conventional EFW and Doppler model. Critically, the CR-FGR excelled in identifying challenging subgroups: it was highly effective for late-onset FGR (AUC 0.876, 95% CI, 0.748–0.951) and successfully detected FGR in many cases with normal umbilical artery Doppler, demonstrating its ability to capture pathology missed by traditional assessment. Conclusions We developed and validated the first machine learning model for FGR prediction based on fetal cardiac remodeling. This model establishes a new diagnostic strategy, offering a powerful, complementary tool that captures direct evidence of fetal compromise. It significantly enhances risk stratification, particularly for the clinically challenging late-onset and Doppler-normal phenotypes of FGR. Trial registration The Chinese Clinical Trial Registry, TRN: ChiCTR2000034182, Registration date: 27 June 2020.

Background Preeclampsia, gestational diabetes mellitus (GDM), and fetal growth restriction (FGR) are maternal complications that affect intrauterine growth and cardiovascular adaptation of fetuses. This study aimed to determine whether early fetal cardiac function predicts birth weight, gestational age at delivery, and the occurrence of maternal and fetal complications. Methods In this prospective cohort, there were 101 singleton pregnancies that had been evaluated at 20-22 gestational weeks using detailed fetal echocardiography. Maternal age, body mass index (BMI) and pregnancy complications (preeclampsia, GDM, FGR) were documented. Fetal parameters of echocardiography were left and right ventricular size, systolic function parameters, stroke volume, and cardiac output. To find the predictors of birth weight, gestational age, and complications, multivariate linear regression was conducted. Results In preeclamptic mothers, fetuses had smaller ventricular dimensions but maintained systolic function, and FGR fetuses had smaller areas of LV end-diastolic and RV end-systolic. GDM was not tied to a significant heart defect in the fetus or birth weight. Maternal age was not linked to any fetal cardiac or birth outcome. These structural alterations in preeclampsia and FGR suggest subclinical cardiac remodeling, detectable in mid-gestation, which may represent early biomarkers of adverse outcomes. Fetal cardiac parameters were not significant predictors of birth weight; however, maternal BMI was strongly associated with birth weight. (p<0.001). Conclusions Early remodelling without functional deficiency is indicated by subclinical structural cardiac variations in preeclampsia and FGR, which highlight the importance of targeted attention during high-risk pregnancy and the use of weight optimization strategies before pregnancy.

Despite significant advancements in the care of patients with hypoplastic left heart syndrome (HLHS) morbidity and mortality remain high. Postnatal right ventricular dysfunction and tricuspid regurgitation (TR) are associated with worse outcomes in HLHS. We aim to determine if right ventricle functional parameters and TR on fetal echocardiogram are associated with postnatal outcomes in HLHS patients. Retrospective review was performed on all fetuses with HLHS from 2014 to 2022 at our institution. Initial and follow up fetal echocardiogram measurements of right ventricular myocardial performance index (MPI), fractional area change (FAC) and global longitudinal strain (GLS) were retrospectively measured. The presence and severity of TR was recorded from the fetal echocardiogram reports. Postnatal outcomes including transplant-free survival, hospital length of stay > 30 days after initial palliation and need for bidirectional Glenn at < 4 months were reviewed. Forty-three subjects met inclusion criteria. Mean gestational age at presentation was 26.1 ± 5.9 weeks. Nine subjects died and 3 required heart transplantation. Initial fetal echocardiogram MPI was significantly lower (better) (0.36 ± 0.06 vs 0.44 ± 0.11; p  =  < 0.001) and FAC was significantly higher (better) (45 ± 6% vs 40 ± 8%; p  = 0.035) in transplant-free survivors. Fetal right ventricular GLS and presence of mild TR were not associated with postnatal outcome. In fetuses with HLHS, abnormal MPI and right ventricular FAC are associated with decreased transplant-free survival. There was no observed association between GLS and postnatal outcomes. To our knowledge this is the first study examining fetal right ventricular function and GLS in HLHS patients and its link to postnatal outcomes.

Background Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging. Methods Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher’s Exact Test and Mann–Whitney- U Test were used for univariant statistical analysis. Results 23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (− 5.36% vs. − 1.57%; p  < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome ( p  < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome ( p  < 0.05). Conclusion In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation.

Background Early-onset growth restriction (eoFGR) has a significantly increased risk of adverse outcomes. This study aimed to apply ultrasonic Doppler measurement and Fetal heart quantification (Fetal HQ) to predict the risk of adverse outcomes in eoFGR fetuses. Methods In this prospective study of singleton pregnancies with eoFGR, fetuses were stratified into a group with adverse outcomes and those without. The primary outcome was the composite adverse outcome,defined as a composite of one or more of the following outcomes: perinatal death, Apgar score < 7 at 5 min, umbilical venous blood pH < 7.0, etc. Exclusion criteria included confirmed fetal structural or chromosomal anomalies, poor-quality ultrasound images, etc. All participants were performed both Doppler ultrasound and Fetal HQ assessment. Independent predictors of adverse outcomes in eoFGR fetuses were identified using multivariable logistic regression analysis. Results We examined 137 normal fetuses and 85 fetuses with eoFGR between 22 and 38 weeks’ gestation. Of these eoFGR cases, 43 were identified with adverse outcomes, and 42 were without. Compared to those without the composite adverse outcome, eoFGR fetuses with it exhibited significantly lower umbilical vein blood flow (UVF) and global sphericity index (GSI), decreased fractional shortening (FS) of right ventricular segments 11–17, and higher rates of umbilical artery (UA) abnormalities, ductus venosus (DV) and coronary artery (CA) dilation. The addition of UVF percentile, CA dilation, or GSI percentile significantly enhanced the AUC for predicting the composite adverse outcome compared to UA abnormalities alone, with the UA abnormalities + UVF percentile combination achieving the highest value. Although the combined model of UA abnormalities, CA dilation, UVF percentile, and GSI percentile achieved the highest AUC of 0.92 for prediction of the composite adverse outcome, it did not yield a statistically significant improvement over the model incorporating only UA abnormalities and UVF percentile (AUC = 0.85). Conclusions Reduced UVF, GSI, Doppler abnormalities in the UA, DV, and CA dilation were associated with the composite adverse outcome in eoFGR fetuses. A model including UVF percentile and UA abnormalities significantly improved the predictive performance for composite adverse outcome compared to models using UA abnormalities alone or supplemented by CA dilation or GSI percentile.

Background Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality. In patients with absent end-diastolic flow (AEDF) in the umbilical artery, placental insufficiency is typically severe, and adverse neonatal outcomes are common. The modified myocardial performance index (Mod-MPI) provides a noninvasive assessment of global fetal cardiac function; however, its relationship with Doppler findings and perinatal outcomes in patients with FGR remains under investigation. Methods This prospective observational study included 217 singleton pregnancies between 24 + 0 and 36 + 0 weeks of gestation. Among these, 103 fetuses were diagnosed with FGR and subdivided on the basis of the presence ( n  = 47) or absence ( n  = 56) of AEDF. The control group included 114 gestational age-matched fetuses with normal growth and Doppler findings. Left ventricular Mod-MPI and cardiac time intervals were measured via a standardized pulsed-wave Doppler technique on the basis of valvular motion timing. The mitral inflow E- and A-wave velocities were also recorded. Perinatal outcomes such as gestational age at delivery, birth weight, 5-minute Apgar score, and NICU admission were compared. Results Although the mean Mod-MPI values were not significantly different between the groups ( p  = 0.38), AEDF-positive fetuses had shorter ejection times and significantly lower mitral E and A velocities ( p  < 0.001). These findings indicate impaired diastolic function. Compared with other groups, AEDF-positive fetuses were delivered earlier, had lower birth weights, and had higher NICU admission rates ( p  < 0.01). Conclusions In fetuses with FGR, the presence of AEDF is associated with early signs of cardiac dysfunction and poor perinatal outcomes. While the mean Mod-MPI may not differ markedly, its components reflect significant hemodynamic compromise. Mod-MPI may be a useful adjunct for monitoring fetal well-being in cases of severe placental insufficiency.

Congenital heart disease (CHD) is the most common fetal anomaly worldwide. The definite etiology of most CHD is not recognized. A direct genetic etiology is considered for a minority of patients. Most etiologies are attributed to epigenetic and environmental factors. Placental malformation is an overlooked cause of CHD that has recently received attention. This narrative review presents a hypothesis based on clinical reports and animal studies. The placenta and fetal heart have concomitant developmental regulatory pathways, and their diseases have a two‐way communication. Placental insufficiency may result in cardiac remodeling. Conversely, placental diseases are more frequent in association with fetal CHD. Fetal vascular malperfusion and genetic defects may play a role in placental and fetal heart disorders. Disturbed embryonic blood flow, such as syncytialization deformities and umbilical cord disorders, may lead to cardiac underdevelopment. Genetic, epigenetic, hormonal, and regulatory factors, including the NOTCH signaling pathway, SUMO‐modulated stress responses, and autophagy‐related genes, can affect both placental and fetal heart development. This novel information about the interplay between the placenta and fetal heart provides a new perspective on the etiologic factors of CHD and placental insufficiency. The current study aims to clarify the common causes of placental and fetal heart disorders.

Objective This study aimed to compare uncomplicated pregnancies and pregnancies complicated by late-onset fetal growth restriction (FGR) in terms of myocardial performance index (MPI) and renal artery pulsatility index (PI), and to explore whether these parameters are associated with adverse perinatal outcomes. Study design This prospective case–control study included 46 uncomplicated pregnancies and 51 pregnancies with late-onset fetal growth restriction. A composite adverse perinatal outcome was defined by the presence of stillbirth, neonatal death, any Apgar score < 7, need for neonatal resuscitation, umbilical cord pH < 7.1, or admission to the neonatal intensive care unit. Results Renal artery PI and MPI values did not differ significantly between pregnancies with late-onset FGR and uncomplicated pregnancies. In the entire cohort, a weak positive correlation was observed between renal artery PI and umbilical cord pH ( r  = 0.206, p  = 0.044), while MPI was negatively correlated with birthweight ( r  = − 0.340, p  = 0.001). Exploratory receiver operating characteristic analyses demonstrated limited discriminative performance of both renal artery PI and MPI for adverse perinatal outcomes. Conclusion Renal artery PI and MPI do not appear to have sufficient predictive value for adverse perinatal outcomes in late-onset FGR. Although MPI was higher in pregnancies complicated by late-onset FGR and showed an association with birthweight, its clinical utility as a standalone diagnostic parameter appears limited.