Effect of Oral Carbohydrate Intake During Labor on the Rate of Instrumental Vaginal Delivery: A Multicenter, Randomized Controlled Trial

Abstract

BACKGROUND: Carbohydrate intake during physical exercise improves muscle performance and decreases fatigue. We hypothesized that carbohydrate intake during labor, which is a period of significant physical activity, can decrease the instrumental vaginal delivery rate. METHODS: In a multicenter, prospective, randomized, controlled trial, healthy adult pregnant women presenting with spontaneous labor were assigned to a “Carbohydrate” group (advised to drink 200 mL of apple or grape juice without pulp every 3 hours) or a “Fasting” group (water only). The primary outcome was the instrumental vaginal delivery rate. Secondary outcomes included duration of labor, rate of cesarean delivery, evaluation of maternal hunger, thirst, stress, fatigue, and overall feeling during labor by numeric rating scale (0 worst rating to 10 best rating), rate of vomiting, and hospital length of stay. Statistical analysis was performed on an intention-to-treat basis. The primary outcome was tested with the “Fasting” group as the reference group. The P values for secondary outcomes were adjusted for multiple comparisons. The differences between groups are reported with 99% confidence interval (CI). RESULTS: A total of 3984 women were analyzed (2014 in the Carbohydrate group and 1970 in the Fasting group). There was no difference in the rate of instrumental delivery between the Carbohydrate (21.0%) and the Fasting (22.4%) groups (difference, −1.4%; 99% CI, −4.9 to 2.2). No differences were found between the Carbohydrate and the Fasting groups for the duration of labor (difference, −7 minutes; 99% CI, −25 to 11), the rate of cesarean delivery (difference, −0.3%; 99% CI, −2.4 to 3.0), the rate of vomiting (difference, 2.8%; 99% CI, 0.2–5.7), the degree of self-reported fatigue (difference, 1; 99% CI, 0–2), self-reported hunger (difference, 0; 99% CI, −1 to 1), thirst (difference, 0; 99% CI, −1 to 1), stress (difference, 0; 99% CI, −1 to 1), overall feeling (difference, 0; 99% CI, 0–0), and the length of hospitalization (difference, 0; 99% CI, −1 to 0). CONCLUSIONS: Carbohydrate intake during labor did not modify the rate of instrumental vaginal delivery.

Effect of a carbohydrate-rich beverage on rate of cesarean delivery in primigravidae with epidural labor analgesia: a multicenter randomized trial

“…Although the calorie intake in the carbohydrate-rich group would be high enough to prevent ketosis as well, we could find rate differences of neither cesarean delivery nor forceps delivery. Similar results were also reported by others comparing low-carbohydrate drinks vs. none-carbohydrate drink or food intake vs. fasting/water drink [ 14 , 17 – 20 , 40 , 41 ]. Thus, taken together, it seems that the content of carbohydrate supplementation does not change mode of delivery.…”

“…In the present study, the overall rate of vomiting during labor was 10.9%, lower than those reported in previous studies (range from 15.6 to 37%) [ 17 , 40 , 50 , 51 ]. Furthermore, the rate of vomiting was lower in the carbohydrate-rich group than in the low-carbohydrate group in our finding.…”

“…Indeed, lack of caloric intake was associated with a higher incidence of instrumental delivery due to non-progressing second stage [ 16 ]. However, available evidence showed that oral carbohydrate ingestion has no effect on labor outcomes [ 14 , 17 – 20 ]. It is noted that, in those studies, the quantity of caloric intake in carbohydrate drink group was low (14 to 47 kcal/h), which may not meet the energy requirement of women in labor.…”

Effects of epidural analgesia on gastric emptying in parturients monitored by ultrasound

“…10 The resultant extremely low incidence of aspiration means we can pay attention to the energy needs of pregnant women during labor. Some studies have found that patients with gastrointestinal dysfunction have a lower incidence of gastroesophageal re ux and vomiting after eating semi-solid food than after consuming liquids [10][11]. Consistent with the dietary culture in China, for many years most parturients have eaten semi-solid food during labor [12].…”