title: Effects of uncomplicated vaginal delivery and epidural analgesia on fetal arterial acid-base parameters at birth in gestational diabetes.
abstract: OBJECTIVE
  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 (84.0mg/dl [4.7 mmol/l], IQR=70-103.3mg/dl vs. 92.5mg/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.
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: F
authors: F
authors: Beneventi
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: E
authors: E
authors: Locatelli
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy. Electronic address: chiara1.c@libero.it.
authors: C
authors: C
authors: Cavagnoli
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: M
authors: M
authors: Simonetta
authors: Department of General Medicine Diabetologic Unit, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: E
authors: E
authors: Lovati
authors: Department of General Medicine Diabetologic Unit, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: P
authors: P
authors: Lucotti
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: P
authors: P
authors: Aresi
authors: Department of Pediatrics and Neonatology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: L
authors: L
authors: Decembrino
authors: Department of Clinical Laboratory, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: R
authors: R
authors: Albertini
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: B
authors: B
authors: Negri
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: A
authors: A
authors: Cavallo
authors: Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
authors: A
authors: A
authors: Spinillo
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology*; D000328:Adult; D015360:Analgesia, Epidural; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D036861:Delivery, Obstetric; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005951:Glucose Tolerance Test; D006801:Humans; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D014469:Umbilical Arteries / Q000502:physiology*
chemical_list: D001786:Blood Glucose
keywords: Epidural analgesia; Fetal arterial acid–base; Gestational diabetes mellitus; Vaginal delivery