Gestational diabetes in mother associated with fetal hypoxia at birth: Study
Finland: Children born to women with gestational diabetes mellitus (GDM) are at increased risk of fetal hypoxia, states a recent study. The study, published in the journal Acta Diabetologica, showed GDM to be associated with intrapartal ZigZag pattern and late decelerations, low 5-min Apgar scores, and cord blood academia at birth.
Gestational diabetes is a form of high blood sugar that affects pregnant women. Worldwide, 16% of live childbirths were associated with some form of maternal hyperglycemia in pregnancy, 84% of which are GDM. If left untreated, it can lead to maternal and fetal complications.
Previous studies have shown cardiotocographic (CTG) fetal heart rate (FHR) monitoring to have only limited benefits in decreasing adverse outcomes in pregnancies with GDM. Considering this Mikko Tarvonen, Helsinki University Central Hospital, Helsinki, Finland, and colleagues aimed to evaluate the association 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.
For this purpose, the researchers recorded intrapartal CTGs in a one-year cohort of 5150 singleton childbirths. 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.
Based on the study, the researchers reported the following findings:
- GDM was diagnosed in 12.1%, OGTT was normal in 79.9%, and OGTT was not performed in 8.0% women.
- Hypoxia-related ZigZag patterns (OR 1.94) and late decelerations (OR 1.65) 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) were observed in those with GDM compared with those without GDM.
"Our findings showed that 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," concluded the authors.
Reference:
The study titled, "Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus," is published in the journal Acta Diabetologica.
DOI: https://link.springer.com/article/10.1007/s00592-021-01756-0
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