Effects of uncomplicated vaginal delivery and epidural analgesia on fetal arterial acid–base parameters at birth in gestational diabetes

Beneventi, Fausta; Locatelli, Elena; Cavagnoli, Chiara; Simonetta, Margherita; Lovati, Elisabetta; Lucotti, Pietro; Aresi, P.; Decembrino, Lidia; Albertini, Riccardo; Negri, Beatrice; Cavallo, Anita; Spinillo, Arsenio

doi:10.1016/j.diabres.2013.12.019

Cited by 7 publications

(11 citation statements)

References 19 publications

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“…UCB acidosis was significantly more detected among these neonates, compared to term neonates who were born to healthy mothers; these results are consistent with other studies (8,15). In the study of Taricco et al, although reduction in oxygen saturation and O 2 content combined with increased lactate concentration were observed in the fetuses of GDM mothers, the rate of UCB acidosis and UCB pH were not different between the GDM and non-GDM mothers (14).…”

Section: Discussionsupporting

confidence: 82%

“…All these changes accelerate poor fetal oxygenation and chronic fetal hypoxemia leading to more fetal acidosis (9,11,13). Additionally in GDM, the increased passage of glucose through the placenta might induce hyperinsulinemia in the fetus, which increases fetal metabolisms and oxygen consumption and causes the accumulation of lactate and a further fall in the pH (8).…”

Section: Discussionmentioning

confidence: 99%

“…Although the value of UC-ABG analysis for prediction of adverse neonatal outcomes in high risk and pre-term deliveries is documented (3)(4)(5)(6), the predictive value of UC-ABG analysis in term deliveries is still controversial; in a study of 51519 term neonates, UCB acidosis was weakly associated with adverse neonatal outcomes (7). UCB acidosis is not always suggestive of acute neonatal stress, rather it can happen in chronic conditions with placental dysfunction including gestational diabetes mellitus (GDM) and preeclampsia (8)(9)(10), in which impairment of placental blood flow can affect trans-placental gas exchange, placing the fetus at risk for chronic hypoxia and acidosis (11)(12)(13). The high rate of chronic fetal acidosis, placental insufficiency in chronic conditions like preeclampsia and GDM (10,14,15), and fetal adaptation to these conditions through changes in fetal circulation might affect the value of UC-ABG analysis in the prediction of adverse neonatal outcomes in these special populations (10); previously, we showed that UCB acidosis might not be a good Copyright © 2018, Iranian Red Crescent Medical Journal.…”

Section: Introductionmentioning

confidence: 99%

“…The use and value of UC-ABG analysis in GDM seems to be even more complicated than other chronic conditions, due to the fact that in addition to placental dysfunction and impairment of utero-placental blood flow that can result in fetal acidosis, impaired maternal glucose metabolism might be another mechanism that induce fetal acidosis; it is shown that excessive glucose in GDM can cross the placenta and induce fetal hyperinsulinemia, accelerated fetal metabolisms, oxygen consumption, and subsequent acidosis (8). Therefore, in GDM fetal acidosis might not only be due to fetal and placental conditions, rather maternal metabolic factors such as glucose and weight control during gestation and during the 24 hours before delivery might also affect UC-ABG parameters.…”

Section: Introductionmentioning

confidence: 99%

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Umbilical Cord Blood Acidosis in Term Pregnancies With Gestational Diabetes Mellitus and Its Relations to Maternal Factors and Neonatal Outcomes

Aalipour

Hantoushzadeh

Shariat

et al. 2018

Iran Red Crescent Med J

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Background: Umbilical cord blood (UCB) gas analysis is recommended in high-risk pregnancies. However, in chronic medical conditions, cord blood acidosis might not indicate acute fetal stress, rather it might be due to fetal adaptation to the chronic stress. Objectives: Evaluating the association between UCB acidosis with maternal factors and adverse neonatal outcomes in term pregnancies with gestational diabetes mellitus. Methods: This prospective cohort evaluated 673 pregnant women who had term pregnancies and were admitted for elective cesarean delivery. A total of 80 women had gestational diabetes. After delivery, a blood sample was obtained from the umbilical artery for arterial blood gas analysis. The neonates were then followed. Results: Term pregnancies with gestational diabetes had significantly higher UCB acidosis rates compared to the healthy controls (26.2% vs. 6%, P < 0.001). In mothers with gestational diabetes, UCB acidosis was independently associated with higher maternal body mass index (P = 0.04) and HbA1C levels (P = 0.01). In the term neonates born to gestational diabetes mothers, after adjustment for gestational age, birth weight and pre-delivery blood glucose, UCB acidosis remained significantly associated with macrosomia (47.6% vs. 23.7%, P = 0.04), neonatal hypoglycemia (76.1% vs. 25.4%, P = 0.002), and moderate-severe jaundice (71.4% vs. 27.1%, p0.01). Conclusions: In our study term, pregnancies with gestational diabetes had a higher rate of UCB acidosis, which was associated with poor maternal glycemic and weight control during the last gestational trimester. UCB acidosis in these pregnancies seems to be independently associated with adverse neonatal outcomes.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Umbilical Cord Blood Acidosis in Term Pregnancies With Gestational Diabetes Mellitus and Its Relations to Maternal Factors and Neonatal Outcomes

Aalipour

Hantoushzadeh

Shariat

et al. 2018

Iran Red Crescent Med J

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“…We did not consider factors such as epidural analgesia and length of labor, which are factors that are known to influence acid‐base status at birth . However, using multiple logistic regression analyses, we evaluated the influence of demographic differences between the AGA and LGA cases, finding no confounding influences.…”

Section: Discussionmentioning

confidence: 99%

Assessment of lactate production as a response to sustained intrapartum hypoxia in large‐for‐gestational‐age newborns

Zaigham

Källén

Olofsson

2018

Acta Obstet Gynecol Scand

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IntroductionLactate concentration in umbilical cord blood is an important measure of intrapartum anaerobic metabolism. The aim of the study was to compare lactate production of large‐for‐gestational‐age (LGA) fetuses against appropriate‐for‐gestational‐age (AGA) fetuses during hypoxia, in diabetic and non‐diabetic mothers.Material and methodsA total of 17 358 validated paired arterial and venous umbilical cord blood samples taken at birth with a full panel of pH, glucose, and lactate were analyzed relative to LGA (n = 2789) and AGA (n = 14 569). Umbilical cord blood acidemia (pH < mean minus 2 SD) was identified in 518 cases.ResultsDiabetes, but not acidemia, was more common among LGA (5.4%) than AGA cases (2.9%) (respectively P < .0001 and P < .69). At normal pH, glucose was lower in non‐diabetes LGA cases, but not in diabetes LGA compared with corresponding AGA cases (respectively P < .0001 and P < .067). Glucose levels were higher in all groups during acidemia (P ≤ .0005), with lower values in non‐diabetes LGA but not in diabetes LGA compared with corresponding AGA cases (respectively P = .005 and P < .58). At normal pH, lactate was lower in non‐diabetes LGA but not in diabetes LGA compared with corresponding AGA cases (respectively P < .0001 and P < .98); during acidemia, lactate levels were higher in all groups (P < .0001), resulting in no significant difference between LGA and AGA in diabetes as well as in non‐diabetes cases (respectively P = .29 and P < .084).ConclusionsConsidering cord acidemia a proxy for intrapartum hypoxia, LGA fetuses showed no impaired ability to produce lactate during hypoxia. Maternal diabetes did not hamper the ability of LGA fetuses to produce lactate during hypoxia.

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Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus

et al. 2021

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Aims In previous reports, cardiotocographic (CTG) fetal heart rate (FHR) monitoring has shown only limited benefits in decreasing adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present study was to evaluate whether an association exists between the recently reported ZigZag pattern (FHR baseline amplitude changes of > 25 bpm with a duration of 2–30 min) and asphyxia-related neonatal outcomes in GDM pregnancies. Methods Intrapartal CTGs were recorded in a one-year cohort of 5150 singleton childbirths. The following CTG changes were evaluated: ZigZag pattern, saltatory pattern, late decelerations, episodes of tachycardia and bradycardia, reduced variability, and uterine tachysystole. The cohort was divided into three groups: women with GDM, women with normal oral glucose tolerance test (OGTT), and women with no OGTT performed. Umbilical artery (UA) blood gases, Apgar scores, neonatal respiratory distress, and neonatal encephalopathy were used as outcome variables. Results GDM was diagnosed in 624 (12.1%), OGTT was normal in 4115 (79.9%), and OGTT was not performed in 411 (8.0%) women. Hypoxia-related ZigZag patterns (OR 1.94, 95% CI 1.64–2.34) and late decelerations (OR 1.65, 95% CI 1.27–2.13) of FHR, as well as a greater risk of fetal asphyxia (UA pH < 7.10 and/or UA BE < -12.0 meq/L and/or Apgar scores < 7 at 5-min) (OR 6.64, 95% CI 1.84–12.03) were observed in those with GDM compared with those without GDM. Conclusions GDM is associated with intrapartal ZigZag pattern and late decelerations, cord blood acidemia and low 5-min Apgar scores at birth indicating increased occurrence of fetal hypoxia in GDM pregnancies.

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Effects of uncomplicated vaginal delivery and epidural analgesia on fetal arterial acid–base parameters at birth in gestational diabetes

Cited by 7 publications

References 19 publications

Umbilical Cord Blood Acidosis in Term Pregnancies With Gestational Diabetes Mellitus and Its Relations to Maternal Factors and Neonatal Outcomes

Umbilical Cord Blood Acidosis in Term Pregnancies With Gestational Diabetes Mellitus and Its Relations to Maternal Factors and Neonatal Outcomes

Assessment of lactate production as a response to sustained intrapartum hypoxia in large‐for‐gestational‐age newborns

Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus

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