Am J Perinatol
DOI: 10.1055/a-1817-5788
Original Article

Maternal diabetes and intrapartum fetal electrocardiogram

Intrapartum fetal ECG in diabetic parturients
1   OB/GYN, NorthShore University HealthSystem, Evanston, United States (Ringgold ID: RIN3271)
Steve Weiner
2   Biostatistics Center, The George Washington University, Rockville, United States
George Saade
3   OB-GYN, UTMB, Galveston, United States
Michael Belfort
4   Obstetrics and Gynecology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
Sean C Blackwell
5   Obstetrics & Gynecology, University of Texas Health Sciences Center at Houston, Houston, United States
John M Thorp
6   University of North Carolina System, Chapel Hill, United States (Ringgold ID: RIN2332)
Alan Tita
7   Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, United States
Russell S Miller
8   Obstetrics and Gynecology, Columbia University Medical Center, New York, United States (Ringgold ID: RIN21611)
David S McKenna
9   The Ohio State University, Columbus, United States (Ringgold ID: RIN2647)
Edward Chien
10   OB GYN Specialist, MetroHealth Medical Center, Cleveland, United States (Ringgold ID: RIN2559)
Dwight J. Rouse
11   Brown University, Providence, United States (Ringgold ID: RIN6752)
Yasser El-Sayed
12   OB/Gyn, Stanford University, Stanford, United States
Yoram Sorokin
13   Ob/GYN, Wayne State University, Detroit, United States (Ringgold ID: RIN2954)
Steve N Caritis
14   University of Pittsburgh, Pittsburgh, United States (Ringgold ID: RIN6614)
› Author Affiliations
Supported by: Neoventa Medical
Supported by: Eunice Kennedy Shriver National Institute of Child Health and Human Development HD21410,HD27869,HD27915,HD27917,HD34208,HD36801,HD40485,HD40500,HD40512,HD40544,HD40545,HD40560,HD53097,HD68268,HD68282

TRIAL REGISTRATION: Registration number (trial ID): NCT01131260, Trial registry: (, Type of Study: Randomized, Multi-Center

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: Secondary analysis of a multi-centered 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 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 pre-gestational diabetes mellitus (DM), gestational DM (GDM), and no DM. Results: Of the 5,436 eligible individuals in the first stage of labor (95 with pre-gestational 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 pre-gestational DM (15%, aOR 2.20, 95% 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 pre-gestational 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.

Publication History

Received: 08 September 2021

Accepted after revision: 22 March 2022

Accepted Manuscript online:
05 April 2022

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