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 language | English |
|---|---|
| Pages (from-to) | 444-451 |
| Number of pages | 8 |
| Journal | Diabetes Research and Clinical Practice |
| Volume | 103 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2014 |
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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 journal › Article
}
TY - JOUR
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
Y1 - 2014
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
UR - http://www.scopus.com/inward/record.url?scp=84898917642&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84898917642&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2013.12.019
DO - 10.1016/j.diabres.2013.12.019
M3 - Article
C2 - 24529563
AN - SCOPUS:84898917642
VL - 103
SP - 444
EP - 451
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
SN - 0168-8227
IS - 3
ER -