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

F. Beneventi, E. Locatelli, C. Cavagnoli, M. Simonetta, E. Lovati, P. Lucotti, P. Aresi, L. Decembrino, R. Albertini, B. Negri, A. Cavallo, A. Spinillo

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aim: To investigate the effects of uncomplicated vaginal delivery and epidural analgesia on fetal acid-base parameters in women with gestational diabetes (GDM) compared with controls. Methods: A retrospective case-control study of 142 women with gestational diabetes and 284 controls. To evaluate the effect of diabetes and analgesia on acid-base status correcting for potential confounders we used ordered logistic equations including quartiles of fetal arterial acid-base parameters collected at birth as outcomes and categories of diabetes and epidural analgesia as explanatory variables. Results: In the GDM group cord base deficit (-2.63. mmol/l, interquartile range [IQR]. = 4.2 to -0.65. mmol/l vs. -1.9. mmol/l, IQR. = -3.3 to -0.2. mmol/l, p= 0.009, odds ratio (OR). = 1.51, 95% confidence interval (CI). = 1.04-2.18) was lower and concentration of calcium higher (1.49. mmol/l, IQR. = 1.42-1.56. mmol/l vs. 1.47. mmol/l, IQR. = 1.41-1.51. mmol/l, p= 0.009, OR. = 1.69, 95% CI. = 1.12-2.56) compared with controls. Epidural analgesia in the GDM group was associated with reduced cord concentration of glucose (84.0. mg/dl [4.7. mmol/l], IQR. = 70-103.3. mg/dl vs. 92.5. mg/dl [5.1. mmol/l], IQR. = 76.5-121.8. mg/dl, p= 0.004), lactate (2.65. mmol/l (IQR. = 1.80-4.20) vs. 3.70. mmol/l (IQR. = 2.90-5.55. mmol/l), p= 0.002) and less pronounced base deficit (-2.05. mmol/l, IQR. = -3.90 to -0.17. mmol/l vs. -2.8, IQR. = -5.57 to -1.05. mmol/l, p= 0.01, OR. = 0.7, 95% CI. = 0.49-0.99). Conclusions: In uncomplicated pregnancies and deliveries, well-controlled gestational diabetes mellitus has potentially significant detrimental effects on fetal acid-base status at birth. Epidural analgesia reduces cord arterial glucose and lactates.

Original languageEnglish
Pages (from-to)444-451
Number of pages8
JournalDiabetes Research and Clinical Practice
Volume103
Issue number3
DOIs
Publication statusPublished - 2014

Fingerprint

Epidural Analgesia
Gestational Diabetes
Parturition
Acids
Odds Ratio
Confidence Intervals
Lactates
Glucose
Analgesia
Case-Control Studies
Lactic Acid
Calcium
Pregnancy

Keywords

  • Epidural analgesia
  • Fetal arterial acid-base
  • Gestational diabetes mellitus
  • Vaginal delivery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Endocrinology

Cite this

Effects of uncomplicated vaginal delivery and epidural analgesia on fetal arterial acid-base parameters at birth in gestational diabetes. / Beneventi, F.; Locatelli, E.; Cavagnoli, C.; Simonetta, M.; Lovati, E.; Lucotti, P.; Aresi, P.; Decembrino, L.; Albertini, R.; Negri, B.; Cavallo, A.; Spinillo, A.

In: Diabetes Research and Clinical Practice, Vol. 103, No. 3, 2014, p. 444-451.

Research output: Contribution to journalArticle

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abstract = "Aim: To investigate the effects of uncomplicated vaginal delivery and epidural analgesia on fetal acid-base parameters in women with gestational diabetes (GDM) compared with controls. Methods: A retrospective case-control study of 142 women with gestational diabetes and 284 controls. To evaluate the effect of diabetes and analgesia on acid-base status correcting for potential confounders we used ordered logistic equations including quartiles of fetal arterial acid-base parameters collected at birth as outcomes and categories of diabetes and epidural analgesia as explanatory variables. Results: In the GDM group cord base deficit (-2.63. mmol/l, interquartile range [IQR]. = 4.2 to -0.65. mmol/l vs. -1.9. mmol/l, IQR. = -3.3 to -0.2. mmol/l, p= 0.009, odds ratio (OR). = 1.51, 95{\%} confidence interval (CI). = 1.04-2.18) was lower and concentration of calcium higher (1.49. mmol/l, IQR. = 1.42-1.56. mmol/l vs. 1.47. mmol/l, IQR. = 1.41-1.51. mmol/l, p= 0.009, OR. = 1.69, 95{\%} CI. = 1.12-2.56) compared with controls. Epidural analgesia in the GDM group was associated with reduced cord concentration of glucose (84.0. mg/dl [4.7. mmol/l], IQR. = 70-103.3. mg/dl vs. 92.5. mg/dl [5.1. mmol/l], IQR. = 76.5-121.8. mg/dl, p= 0.004), lactate (2.65. mmol/l (IQR. = 1.80-4.20) vs. 3.70. mmol/l (IQR. = 2.90-5.55. mmol/l), p= 0.002) and less pronounced base deficit (-2.05. mmol/l, IQR. = -3.90 to -0.17. mmol/l vs. -2.8, IQR. = -5.57 to -1.05. mmol/l, p= 0.01, OR. = 0.7, 95{\%} CI. = 0.49-0.99). Conclusions: In uncomplicated pregnancies and deliveries, well-controlled gestational diabetes mellitus has potentially significant detrimental effects on fetal acid-base status at birth. Epidural analgesia reduces cord arterial glucose and lactates.",
keywords = "Epidural analgesia, Fetal arterial acid-base, Gestational diabetes mellitus, Vaginal delivery",
author = "F. Beneventi and E. Locatelli and C. Cavagnoli and M. Simonetta and E. Lovati and P. Lucotti and P. Aresi and L. Decembrino and R. Albertini and B. Negri and A. Cavallo and A. Spinillo",
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T1 - Effects of uncomplicated vaginal delivery and epidural analgesia on fetal arterial acid-base parameters at birth in gestational diabetes

AU - Beneventi, F.

AU - Locatelli, E.

AU - Cavagnoli, C.

AU - Simonetta, M.

AU - Lovati, E.

AU - Lucotti, P.

AU - Aresi, P.

AU - Decembrino, L.

AU - Albertini, R.

AU - Negri, B.

AU - Cavallo, A.

AU - Spinillo, A.

PY - 2014

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N2 - Aim: To investigate the effects of uncomplicated vaginal delivery and epidural analgesia on fetal acid-base parameters in women with gestational diabetes (GDM) compared with controls. Methods: A retrospective case-control study of 142 women with gestational diabetes and 284 controls. To evaluate the effect of diabetes and analgesia on acid-base status correcting for potential confounders we used ordered logistic equations including quartiles of fetal arterial acid-base parameters collected at birth as outcomes and categories of diabetes and epidural analgesia as explanatory variables. Results: In the GDM group cord base deficit (-2.63. mmol/l, interquartile range [IQR]. = 4.2 to -0.65. mmol/l vs. -1.9. mmol/l, IQR. = -3.3 to -0.2. mmol/l, p= 0.009, odds ratio (OR). = 1.51, 95% confidence interval (CI). = 1.04-2.18) was lower and concentration of calcium higher (1.49. mmol/l, IQR. = 1.42-1.56. mmol/l vs. 1.47. mmol/l, IQR. = 1.41-1.51. mmol/l, p= 0.009, OR. = 1.69, 95% CI. = 1.12-2.56) compared with controls. Epidural analgesia in the GDM group was associated with reduced cord concentration of glucose (84.0. mg/dl [4.7. mmol/l], IQR. = 70-103.3. mg/dl vs. 92.5. mg/dl [5.1. mmol/l], IQR. = 76.5-121.8. mg/dl, p= 0.004), lactate (2.65. mmol/l (IQR. = 1.80-4.20) vs. 3.70. mmol/l (IQR. = 2.90-5.55. mmol/l), p= 0.002) and less pronounced base deficit (-2.05. mmol/l, IQR. = -3.90 to -0.17. mmol/l vs. -2.8, IQR. = -5.57 to -1.05. mmol/l, p= 0.01, OR. = 0.7, 95% CI. = 0.49-0.99). Conclusions: In uncomplicated pregnancies and deliveries, well-controlled gestational diabetes mellitus has potentially significant detrimental effects on fetal acid-base status at birth. Epidural analgesia reduces cord arterial glucose and lactates.

AB - Aim: To investigate the effects of uncomplicated vaginal delivery and epidural analgesia on fetal acid-base parameters in women with gestational diabetes (GDM) compared with controls. Methods: A retrospective case-control study of 142 women with gestational diabetes and 284 controls. To evaluate the effect of diabetes and analgesia on acid-base status correcting for potential confounders we used ordered logistic equations including quartiles of fetal arterial acid-base parameters collected at birth as outcomes and categories of diabetes and epidural analgesia as explanatory variables. Results: In the GDM group cord base deficit (-2.63. mmol/l, interquartile range [IQR]. = 4.2 to -0.65. mmol/l vs. -1.9. mmol/l, IQR. = -3.3 to -0.2. mmol/l, p= 0.009, odds ratio (OR). = 1.51, 95% confidence interval (CI). = 1.04-2.18) was lower and concentration of calcium higher (1.49. mmol/l, IQR. = 1.42-1.56. mmol/l vs. 1.47. mmol/l, IQR. = 1.41-1.51. mmol/l, p= 0.009, OR. = 1.69, 95% CI. = 1.12-2.56) compared with controls. Epidural analgesia in the GDM group was associated with reduced cord concentration of glucose (84.0. mg/dl [4.7. mmol/l], IQR. = 70-103.3. mg/dl vs. 92.5. mg/dl [5.1. mmol/l], IQR. = 76.5-121.8. mg/dl, p= 0.004), lactate (2.65. mmol/l (IQR. = 1.80-4.20) vs. 3.70. mmol/l (IQR. = 2.90-5.55. mmol/l), p= 0.002) and less pronounced base deficit (-2.05. mmol/l, IQR. = -3.90 to -0.17. mmol/l vs. -2.8, IQR. = -5.57 to -1.05. mmol/l, p= 0.01, OR. = 0.7, 95% CI. = 0.49-0.99). Conclusions: In uncomplicated pregnancies and deliveries, well-controlled gestational diabetes mellitus has potentially significant detrimental effects on fetal acid-base status at birth. Epidural analgesia reduces cord arterial glucose and lactates.

KW - Epidural analgesia

KW - Fetal arterial acid-base

KW - Gestational diabetes mellitus

KW - Vaginal delivery

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