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We sought to determine the independent impact of maternal DM on fetal cardiac function in middle pregnancy. We prospectively recruited mothers with all categories of DM and non-diabetic healthy controls (NDC). Echocardiograms were optimized for chamber quantification and strain analysis. Left atrial area (LAA), LA strain (LAS), right atrial strain (RAS), global longitudinal ventricular strain (GLS) and Right ventricular free wall strain (RV FWS) were evaluated by 2 blinded operators. After excluding 9 mothers with poor fetal image quality, images from 104 mothers with DM and 47 NDC were analyzed. Mothers with DM and NDCs were well matched for age, blood pressure, smoking prevalence, and gestational age. Fetal heart rate (FHR) was significantly higher in fetuses of mothers with DM compared to NDC (147\u2009\u00b1\u200910\u00a0bpm vs. 144\u2009\u00b1\u20098, p\u2009=\u20090.04). LAA in fetuses of mothers with DM trended towards being larger in size (1.68\u2009\u00b1\u20090.4cm<jats:sup>2<\/jats:sup> vs. 1.56\u2009\u00b1\u20090.4cm<jats:sup>2<\/jats:sup>, p\u2009=\u20090.08). Fetal septal diameters were larger in maternal DM compared to NDC (2.7\u2009\u00b1\u20090.5\u00a0cm vs. 2.5\u2009\u00b1\u20090.5\u00a0cm, p\u2009=\u20090.001). GLS was similar between the groups. Fetal LAS was lower in maternal DM (28.8\u2009\u00b1\u20098.8% vs. 33.3\u2009\u00b1\u200910.4%, p\u2009=\u20090.007) and was independently associated with maternal DM after adjusting for GLS and FHR. Fetal RAS was lower in maternal DM (27.7\u2009\u00b1\u200910.4% vs. 31.8\u2009\u00b1\u200910.3%, p\u2009=\u20090.007), however only determinates were estimated fetal weight and RV FWS. Maternal DM independently impairs fetal LA function in mid pregnancy. These early functional changes in the developing heart warrant future studies investigating impact on cardiovascular health.<\/jats:p>","DOI":"10.1007\/s10554-024-03194-9","type":"journal-article","created":{"date-parts":[[2024,7,27]],"date-time":"2024-07-27T11:02:03Z","timestamp":1722078123000},"page":"1987-1994","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of maternal diabetes mellitus on fetal atrial strain"],"prefix":"10.1007","volume":"40","author":[{"given":"Faraz","family":"Pathan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Penny","family":"Lam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shanthosh","family":"Sivapathan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahab","family":"Pathan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyu","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Orde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deva","family":"Nirthanakumaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Negishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Nanan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,7,27]]},"reference":[{"key":"3194_CR1","doi-asserted-by":"publisher","first-page":"107841","DOI":"10.1016\/j.diabres.2019.107841","volume":"157","author":"L Yuen","year":"2019","unstructured":"Yuen L, Saeedi P, Riaz M et al (2019) Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: results from the International Diabetes Federation Diabetes Atlas, 9th edition. 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