High pre-operative HbA1c in women with GDM tied to higher opioids need after CS: Study
China: The pre-operative HbA1c in pregnant women with gestational diabetes (GDM) is independently associated with the need for and consumption of analgesics 24 hours after cesarean section, says a recent study published in Frontiers in Endocrinology.
The findings indicate that close monitoring of HbA1c should be done in women with GDM and advanced maternal age or a history of CS. This would be helpful to provide personalized treatment and improve the quality of and satisfaction with postoperative analgesia.
Compared to women without GDM, women with GDM had a higher consumption and need for analgesics. In diabetic patients, the preoperative level of HbA1c was shown to be associated with postoperative analgesics consumption. Considering this, Chen Yang, Department of Anaesthesiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China, and colleagues undertook a prospective observational study to investigate further the relationship between the pre-operative HbA1c and the post-operative consumption of analgesics in women with GDM.
The study included women with GDM and a singleton pregnancy undergoing elective cesarean section under combined spinal-epidural anesthesia. Based on pre-operative HbA1c, they were divided into group HbA1c < 6% and group HbA1c ≥ 6%. A comparison of analgesics consumption, number of patient-controlled analgesia (PCA) compression, and pain scores in 6 hours and 24 hours post-operation was done between the two groups. To investigate possible independent predictors of post-operative 24-hour sufentanil consumption, Pearson's correlation coefficient and a stepwise multivariate linear regression were performed.
The key findings of the study are as follows:
- Analgesics consumption was significantly lower (18.8 ± 0.4 vs 23.2 ± 4.3; 82.7 ± 2.4 vs 115.8 ± 17.4), and a number of PCA compressions was significantly less frequent (1 vs 3; 5 vs 7), and in group HbA1c < 6% than in group HbA1c ≥ 6% in 6 hours and 24 hours post-operation.
- The univariate analysis showed that sufentanil consumption at 24 hours post-operation was significantly related to pre-operative HbA1c (r = 0.338) and parity (r = 0.184) and was related to blood glucose management methods (r = 0.172).
- Multivariate linear regression analysis showed that HbA1c was the independent factor related to post-operative 24-hour sufentanil consumption (adjusted r2 = 0.246).
"Our study shows that in pregnant women with GDM, the pre-operative HbA1c is independently related to the need for and consumption of analgesics in 24 hours after CS," the authors conclude.
Reference:
Yang C, Li Y, Hu J, Wu J and Huang S (2022) The Relationship Between Pre-Operative Glycosylated Haemoglobin and Opioid Consumption After Caesarean Section in Women With Gestational Diabetes Mellitus. Front. Endocrinol. 13:910914. doi: 10.3389/fendo.2022.910914
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