Ultrasound Assessment of the Fetal Pancreas in Normal and Abnormal Pregnancies: A Narrative Review

Fetal pancreatic development is central to intrauterine glucose-insulin homeostasis and may influence lifelong metabolic risk. Advances in obstetric ultrasonography now allow in-utero assessment of pancreatic size, morphology, and echotexture, offering a non-invasive window into fetal metabolic adaptation across normal and high-risk pregnancies. A narrative review was conducted using electronic databases to identify human studies reporting sonographic evaluation of the fetal pancreas, including measurements of circumference, diameter, area, segmental lengths, derived ratios, and echogenicity grading, in relation to maternal metabolic status, fetal growth, and perinatal outcomes. Given methodological heterogeneity, a qualitative, theme-based synthesis was performed. Studies demonstrate that pancreatic biometry can be obtained reproducibly from mid-gestation, with strong correlations to gestational age, abdominal circumference, and estimated fetal weight. In diabetic pregnancies, pancreas size and echogenicity increase with maternal glycemic burden and are associated with fetal overgrowth and adverse neonatal outcomes. Mid-trimester pancreatic measurements and echogenicity show variable but promising performance for early gestational diabetes prediction. In contrast, most fetuses with established late-onset fetal growth restriction exhibit reduced pancreatic size, whereas novel diameter-based ratios may identify low-birthweight risk earlier. Targeted imaging aids diagnosis of structural and genetic pancreatic anomalies. Standardized ultrasound assessment of the fetal pancreas has evolved into a feasible, clinically informative adjunct to conventional biometry, reflecting the fetal response to diabetic exposure, growth restriction, and syndromic disease. Harmonized protocols, multicenter validation, and long-term metabolic follow-up are needed before pancreas-based parameters can be incorporated into routine prenatal risk stratification.