Ursodeoxycholic acid may improve left atrial function in women with gestational diabetes
Key takeaway:
A randomized trial in 113 women with gestational diabetes found that ursodeoxycholic acid was associated with small improvements in left atrial function in the third trimester and postpartum, suggesting possible cardiovascular benefits beyond glycemic control.
Study at a glance
What was studied
Effect of UDCA on maternal cardiac function in gestational diabetes
Study type
Randomized Controlled Trials (RCTs)
duration
Medium-Term (3–12 mo)
Intervention
Ursodeoxycholic acid (UDCA)
Outcomes
Left atrial reservoir strain (echocardiography), Left atrial contractile strain (echocardiography), Left ventricular ejection fraction (LVEF)
Funding
Non-industry sponsored
Main effects
UDCA ↑ Left atrial contractile strain at 36 weeks (LASct_AC, p=0.016) compared to placebo ↓
UDCA ↑ Left atrial reservoir function postpartum (LASr_ED p=0.041, LASr_AC p=0.036) ↓
No significant differences in left ventricular ejection fraction or right ventricular function ↓
Evidence Summary
| Intervention | Outcome | Measured Change | Study Effect |
|---|---|---|---|
 Ursodeoxycholic acid (UDCA) (Supplements) |  Left atrial contractile strain (echocardiography) (Metabolic Health) | Increase | Limited |
Ursodeoxycholic acid (UDCA) (Supplements) | Left atrial reservoir strain (echocardiography) (Metabolic Health) | Increase | Limited |
Ursodeoxycholic acid (UDCA) (Supplements) | Left ventricular ejection fraction (LVEF) (Metabolic Health) | Uncertain | Limited |
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Evidence Suggest
- UDCA associated with improved atrial function but not ventricular systolic function
- Effects were time-dependent: contractile changes in late pregnancy, reservoir/conduit changes postpartum
- Per-protocol analysis with post-randomization exclusion limits causal interpretation
Who this applies to
This study applies to women diagnosed with gestational diabetes mellitus who are being treated with standard glycemic management and may have interest in additional cardiovascular protective therapies during and after pregnancy.
Keep in Mind
This is a cardiac sub-study from a single-center trial that was not powered for echocardiographic outcomes. The per-protocol analysis (excluding UDCA-treated women with low drug levels) may introduce bias. The clinical significance of small changes in left atrial strain parameters is uncertain without long-term follow-up data.
Between the Lines
- Per-protocol analysis (not ITT) introduces potential selection bias
- Cardiac outcomes were secondary endpoints, trial not powered for these
- No correction for multiple comparisons; borderline p-values may be chance findings
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Journal Reference
Calabuig AMC, Blanco-Carnero JE, Chatzakis C, et al. The Impact of Ursodeoxycholic Acid on Maternal Cardiac Function in Women with Gestational Diabetes Mellitus: A Randomized Controlled Study (GUARDS Trial). J Clin Med. 2026;15(2):786. doi:10.3390/jcm15020786
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