Pregnancy can come with many extra layers of care, especially for patients with pregestational diabetes—meaning diabetes that existed before pregnancy began. One of the biggest concerns in these pregnancies is the increased risk of congenital heart disease (CHD), or heart problems a baby is born with. Because of this risk, many guidelines recommend that all of these pregnancies include a fetal echocardiogram, a specialized ultrasound focused only on the baby’s heart.

But is that always necessary?

A new study suggests that in some settings, there may be another way.

Researchers looked at how a selective referral program worked for pregnant patients with type 1 or type 2 diabetes at a large, experienced medical center. Instead of automatically sending every patient for a fetal echocardiogram, the team used detailed anatomy ultrasounds first. These routine scans included expanded views of the baby’s heart and were performed by highly trained ultrasound professionals. If something looked unusual, or if the images weren’t clear enough, the patient would then be referred for the more specialized heart exam.

The goal was simple: find out whether this approach could still catch serious heart problems before birth.

The findings were encouraging.

The study showed that all of the major heart conditions in the babies were identified before delivery, even though only a portion of patients went on to receive a fetal echocardiogram. This suggests that when detailed anatomy scans are performed carefully and by experienced teams, they may be enough to spot the most serious concerns.

Some smaller or less serious heart differences were not found until after birth. However, these were minor issues that did not require urgent treatment and are often difficult to detect before delivery.

This distinction matters.

Not every heart difference has the same impact. Some conditions need immediate care after birth, while others may simply need monitoring over time. The study’s selective approach focused on making sure the most urgent and life-changing conditions were found early.

Why is this important?

Fetal echocardiograms are valuable, but they also require specialized equipment, trained staff, and time. In many healthcare systems, these resources are limited. Reducing unnecessary referrals could help shorten wait times and improve access for patients who need these exams most.

It may also help reduce stress for expectant parents. Being referred for additional testing can create anxiety, even when everything turns out normal. A strong initial screening process may help avoid some of that uncertainty.

The study also highlights the importance of ultrasound quality. The success of this selective system depended on advanced imaging techniques and experienced sonographers and physicians. That means this approach may not work the same way in every clinic or hospital. Centers with fewer resources or less specialized training may still benefit from universal fetal echocardiograms for these higher-risk pregnancies.

For now, this research adds to a growing conversation in maternal-fetal care: how can healthcare teams provide the best care while also using resources wisely?

The answer may not be one-size-fits-all. But studies like this show that with the right expertise and technology, more personalized approaches to prenatal care may be possible.

Want to learn more? Read the full study in the American Institute of Ultrasound in Medicine’s (AIUM’s) Journal of Ultrasound in Medicine here https://onlinelibrary.wiley.com/doi/10.1002/jum.70324

AIUM members always have full access to the journal; not a member? Join here.

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).