Fetal Cardiac Function and Global Longitudinal Strain in Preeclampsia: A Systematic Review and Meta‐Analysis

ABSTRACT Objective To systematically review and synthesize the evidence on fetal cardiac function in pregnancies complicated by preeclampsia, with a primary focus on the diagnostic utility of global longitudinal strain (GLS) as a sensitive tool for identifying subclinical myocardial dysfunction within the broader spectrum of echocardiographic tools and techniques. Methods In accordance with PRISMA 2020 guidelines (PROSPERO registration CRD420251087490), searches were performed in PubMed and LILACS (2000–July 2025) for studies reporting echocardiographic functional parameters in fetuses of PE pregnancies versus healthy controls. Eligible designs included observational cohort and case–control studies. Data extraction and bias assessment (Newcastle–Ottawa Scale) were independently performed by two reviewers. Pooled analyses of left (LV) and right ventricular (RV) global longitudinal strain (GLS) were performed using OpenMeta. Results Nine studies, comprising 8353 fetuses, were included. Conventional parameters (E/A ratio, TAPSE, MPI, FS) demonstrated modest differences between groups, though MPI results were inconsistent. GLS analysis demonstrated consistent results RV GLS was significantly reduced in PE pregnancies, with reductions most evident in late gestation. In contrast, meta‐analysis revealed no significant overall difference in LV GLS between PE and controls and was limited to subtle strain reductions at mid‐gestation or in severe early‐onset cases. Conclusions Preeclampsia is associated with impaired RV deformation, reflecting increased placental resistance and fetal hemodynamic load. Strain imaging demonstrates higher sensitivity than conventional indices, supporting its potential role in fetal cardiac assessment and postnatal cardiovascular follow‐up.