Comparison of Diffusion-Weighted Magnetic Resonance Imaging of the Fetal Brain in Pregnant Women with Gestational Diabetes Mellitus and in Normal Fetuses: A Matched Case-Control Study

OBJECTIVES: Comparison of fetal neurodevelopmental indicators between women with gestational diabetes mellitus and those without gestational diabetes mellitus using brain DWI. METHODS: A total of 146 pregnant women with gestational diabetes mellitus and 146 normal pregnant women matched 1:1 by maternal age and gestational age (26-40 weeks) were included in the study. Parametric analyses were performed using the t-test, while non-parametric analyses were conducted with the Mann-Whitney U test to compare differences between the gestational diabetes mellitus and control groups. Categorical variables were analyzed using the chi-square test. Subsequently, linear regression analysis was applied to evaluate the association between ADC values and fetal gestational age. RESULTS: < 0.05). CONCLUSIONS: The differences in ADC values between the gestational diabetes mellitus and normal fetal groups in intracranial regions, including the MBH, BG, THAL, pons, CSO, PWM, and OWM, were statistically significant, which may provide preliminary evidence that gestational diabetes mellitus exposure is associated with altered fetal brain microstructure, as indicated by region-specific reductions in ADC values. CRITICAL RELEVANCE STATEMENT: This exploratory, preliminary case-control study shows region-specific fetal brain ADC changes on DWI associated with gestational diabetes mellitus exposure, offering early in utero imaging clues to microstructural alterations that may inform future neurodevelopmental risk evaluation. HIGHLIGHTS: 1 Neurodevelopmental differences between fetuses of pregnant women with gestational diabetes mellitus and in healthy pregnancies remain uncertain. 2 Significant differential changes in the development of different brain regions distributed across gestational weeks in gestational diabetes mellitus exposed fetuses were noted compared to those in normal fetuses. 3 This exploratory study identifies gestational diabetes mellitus related fetal brain ADC alterations, offering preliminary in utero imaging evidence to advance prenatal neurodevelopmental radiological assessment.