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Background/Introduction: Diabetes impacts 12- 14% of pregnancies. Evaluating the impact of maternal diabetes on the fetal heart is challenging due to variable image quality and limited time for structural changes to manifest. Left atrial reservoir strain (ER) is a sensitive marker of early left atrial dysfunction which may elucidate fetal atrial dysfunction resulting from maternal diabetes. Purpose We sought to evaluate if fetal ER can detect impairment of left atrial function in the fetal heart as a result of maternal diabetes. Methods We performed a prospective observational study evaluating patients who were referred to the high risk pregnancy service as a result of maternal diabetes (pre-existing or gestational) and healthy controls. Patients were excluded if adequate imaging of the fetal myocardium was not possible. Baseline characteristics of the mother and cardio-metabolic risk factors were recorded. The fetal echocardiogram focused on the 4 chamber view. We used the 4 chamber view with closure of the mitral valve as the zero reference point (R-R) gating. The strain curves from 6 atrial segments were averaged. Normality of the data was assessed using the Shapiro-Wilk test. The Mann-Whitney U test was used to compare ER between fetuses, whose mothers had diabetes versus those fetuses whose mothers were healthy controls. Results A total of 120 fetal scans were performed. 5 were excluded due to poor image quality, which prevented strain analysis. 115 fetal scans were analysed (87 with maternal diabetes and 27 healthy controls). The diabetic subjects and controls did not defer significantly in age Mean ± SD (31± 5 vs 30± 5, p= 0.81). The mothers with diabetes had a higher body mass index than controls (Median [IQR]) (30.5 kg/m2 [25.1, 35.3] vs 24.6 kg/m2 [22.1, 28.6] p &amp;lt; 0.001). The presence of maternal diabetes resulted in lower fetal ER (28.5% [22.1, 36.2] vs 33.4% [26.6, 41.6] P = 0.01). Figure 1 illustrates the Box-Whisker plot comparing Fetal ER between fetuses exposed to maternal diabetes and fetuses where mothers were healthy controls. Conclusion The presence of maternal diabetes results in impaired fetal left atrial function as measured by fetal left atrial strain (ER). Abstract P1378 Figure 1

P1378 Impact of maternal diabetes on fetal left atrial function