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 journalArticlepeer-review

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

Keywords

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

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Endocrinology

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