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Objective To determine whether cardiac functional and structural changes in fetuses of mothers with gestational diabetes mellitus (GDM) persist in the offspring beyond the neonatal period. Design Longitudinal study. Setting Fetal Medicine Unit in a UK teaching hospital. Methods 73 women with GDM and 73 women with uncomplicated pregnancy were recruited and fetal cardiac scans were performed at 35-36 weeks' gestation. Repeat echocardiogram was performed in their offspring during infancy. Main outcome measures Fetal and infant cardiac functional and structural changes. Results Fetuses of mothers with GDM, compared with controls, had more globular right ventricles (sphericity index 0.7, interquartile range [IQR] 0.6/0.7 versus 0.6, IQR 0.5/0.6, P < 0.001) and reduced right global longitudinal systolic strain (À16.4, IQR À18.9/À15.3 versus À18.5, IQR À20.6/À16.8, P = 0.001) and left global longitudinal systolic strain (À20.1, IQR À22.5/À16.9 versus À21.3, IQR À23.5/À19.5), P = 0.021). In the GDM group, compared with controls, in infancy there was higher left ventricular E/e' (