Background: Coronavirus disease 2019 (COVID-19) has been shown to affect the cardiovascular system and may influence fetal development during pregnancy. However, data regarding its impact on fetal cardiac function remain limited.

Objective: To evaluate the diagnostic significance of fetal echocardiography in assessing cardiac functional changes in fetuses of pregnant women who experienced COVID-19 infection during the second and third trimesters.

Materials and Methods: A total of 124 pregnant women with a confirmed history of COVID-19 infection during the second and third trimesters were included in the study. All participants were receiving care at the Khorezm Regional Perinatal Center. Fetal echocardiography was performed four weeks after clinical recovery. Assessment of fetal cardiac function included evaluation of diastolic and systolic parameters using mitral and tricuspid E/A ratios, myocardial performance index (MPI), and cardiac chamber dimensions. The control group consisted of gestational age–matched healthy pregnant women without a history of COVID-19 infection. Statistical analysis was performed using appropriate parametric tests, with results expressed as p-values and effect sizes calculated using Cohen’s d.

Results: Fetuses of mothers with prior COVID-19 infection demonstrated a significant decrease in mitral valve E/A ratio, indicating impaired diastolic relaxation (p < 0.05). An increase in MPI suggested subclinical global myocardial dysfunction. These changes were more pronounced in the third trimester compared to the second trimester.

Conclusion: Fetal echocardiography is a highly informative and non-invasive method for early detection of functional cardiac alterations in fetuses of pregnant women after COVID-19 infection. Its routine use may improve prenatal monitoring and pregnancy management in this population.

COVID-19, pregnancy, fetal echocardiography, myocardial performance index, diastolic dysfunction.