Strengths and limitations
Strengths of our study include, first, longitudinal cardiovascular
assessment in pregnancies affected only by GDM without the confounding
effect of pregestational diabetes, which could potentially affect early
embryonic development and alter cardiac morphogenesis and placental
development. Second, by performing detailed cardiac functional
evaluation from fetal to postnatal life, we were able to detect subtle
fetal cardiac functional changes and track these through the first year
of life. Cardiac measurements were performed using advanced
echocardiographic modalities and following strict imaging protocols.
Third, trained fellows blinded to maternal characteristics performed
analysis to avoid any bias in the results. The main limitation of the
study is that fetal speckle tracking analysis was performed using one
analysis platform and as such the measurements may not be generalizable
to those generated by other software(15). Another limitation was that
although we aimed to have the same interval after delivery for postnatal
cardiac assessment for the GDM and controls, this was not achieved and
there was a mean difference of 4 months between the groups; however, we
accounted for this discrepancy in the multivariable analysis.