We observed that SGLT-2 inhibition had an indirect effect on the total effect of HF (OR 0.86 [95% CI 0.74–0.96], P = 0.0160) through CXCL10, with a mediation proportion of 17.85% (95% CI [3.03%–32.68%], P = 0.0183) (Central Illustration and Fig. 3). Here, CXCL10 is linked to hydrops fetalis.