Maternal Diabetes and Intrapartum Fetal Electrocardiogram

Author:

Plunkett Beth A.1ORCID,Weiner Steven J.2,Saade George R.3,Belfort Michael A.4,Blackwell Sean C.5,Thorp John M.6,Tita Alan T. N.7,Miller Russell S.8,McKenna David S.9,Chien Edward K. S.10,Rouse Dwight J.11,El-Sayed Yasser Y.12,Sorokin Yoram13,Caritis Steve N.14,

Affiliation:

1. Department of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois

2. the George Washington University Biostatistics Center, Washington, Dist. Of Columbia

3. University of Texas Medical Branch, Galveston, Texas

4. University of Utah Health Sciences Center, Salt Lake City, Utah

5. University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas

6. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

7. University of Alabama at Birmingham, Birmingham, Alabama

8. Columbia University, New York, New York

9. The Ohio State University, Columbus, Ohio

10. MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio

11. Brown University, Providence, Rhode Island

12. Stanford University, Stanford, California

13. Wayne State University, Detroit, Michigan

14. University of Pittsburgh, Pittsburgh, Pennsylvania

Abstract

Objective Fetal electrocardiogram (ECG) ST changes are associated with fetal cardiac hypoxia. Our objective was to evaluate ST changes by maternal diabetic status and stage of labor. Methods This was a secondary analysis of a multicentered randomized-controlled trial in which laboring patients with singleton gestations underwent fetal ECG scalp electrode placement and were randomly assigned to masked or unmasked ST-segment readings. Our primary outcome was the frequency of fetal ECG tracings with ST changes by the stage of labor. ECG tracings were categorized into mutually exclusive groups (ST depression, ST elevation without ST depression, or no ST changes). We compared participants with DM, gestational diabetes mellitus (GDM), and no DM. Results Of the 5,436 eligible individuals in the first stage of labor (95 with pregestational DM and 370 with GDM), 4,427 progressed to the second stage. ST depression occurred more frequently in the first stage of labor in participants with pregestational DM (15%, adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.14–4.24) and with GDM (9.5%, aOR 1.51, 95% CI 1.02–2.25) as compared with participants without DM (5.7%). The frequency of ST elevation was similar in participants with pregestational DM (33%, aOR 0.79, 95% CI 0.48–1.30) and GDM (33.2%, aOR 0.91, 95% CI 0.71–1.17) as compared with those without DM (34.2%). In the second stage, ST depression did not occur in participants with pregestational DM (0%) and occurred more frequently in participants with GDM (3.5%, aOR 2.01, 95% CI 1.02–3.98) as compared with those without DM (2.0%). ST elevation occurred more frequently in participants with pregestational DM (30%, aOR 1.81, 95% CI 1.02–3.22) but not with GDM (19.0%, aOR 1.06, 95% CI 0.77–1.47) as compared with those without DM (17.8%). Conclusion ST changes in fetal ECG occur more frequently in fetuses of diabetic mothers during labor. ClinicalTrials.gov number, NCT01131260. Precis: ST changes in fetal ECG, a marker of fetal cardiac hypoxia, occur more frequently in fetuses of diabetic parturients. Key Points

Funder

Neoventa Medical

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

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