Objective　To assess the cost and effectiveness of the referral efficiency in the fetal cardiac screening of diabetic pregnancies. Method　Theoretical minimized cost analysis was performed in 199 diabetic pregnancies, to evaluate the cost and effectiveness of the screening strategy for these referrals. Results　In pregnancies referred for diabetes mellitus, nine children with congenital heart disease were finally screened out. The current cardiac screening strategy of anatomic survey and fetal echocardiography for all diabetic pregnancies, and postnatal echocardiography only for cases with prenatal detection of congenital heart disease or even benign findings as indicated, would cost 13045.67 CNY for each prenatal detection of congenital heart disease. If fetal echocardiography was performed in diabetic pregnancies with other referral indications and postnatal echocardiography were performed only in cases with prenatal detection of congenital heart disease or other benign findings, the cost of each prenatal detection of congenital heart disease would decrease to 8475.22 CNY. Conclusion　The economic analysis of diabetic pregnancies indicated that, the cardiac screening strategy of selective fetal echocardiography for diabetic pregnancies with other referral indications for fetal echocardiography after fetal anatomic survey and selective postnatal echocardiography only for cases with prenatal cardiac findings, was more cost-effective.