Ursodeoxycholic acid may improve left atrial function in women with gestational diabetes
Last updated May 16, 2026
Key finding
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.
This randomized trial tested whether ursodeoxycholic acid (UDCA), a bile acid medication, could improve heart function in pregnant women with gestational diabetes. Women who received UDCA showed small improvements in left atrial function during late pregnancy and 3 months after giving birth compared to placebo, though overall heart function changes were modest.
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Study at a glance
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EvidenceScore™
Moderate
Study type
Randomized Controlled Trials (RCTs)
Follow-up
Medium-Term (3–12 mo)
Risk of bias
Some Concerns
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Plain-language summary
What this paper says
A plain-language read of the study’s main message and where it applies.
Study focus
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.
Published in
Journal Reference
Publication details and source links for this paper.
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
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 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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