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

Maternal Diabetes and Intrapartum Fetal Electrocardiogram

1   Department of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois
Steven J. Weiner
2   the George Washington University Biostatistics Center, Washington, Dist. Of Columbia
George R. Saade
3   University of Texas Medical Branch, Galveston, Texas
Michael A. Belfort
4   University of Utah Health Sciences Center, Salt Lake City, Utah
Sean C. Blackwell
5   University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas
John M. Thorp Jr.
6   University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Alan T. N. Tita
7   University of Alabama at Birmingham, Birmingham, Alabama
Russell S. Miller
8   Columbia University, New York, New York
David S. McKenna
9   The Ohio State University, Columbus, Ohio
Edward K. S. Chien
10   MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
Dwight J. Rouse
11   Brown University, Providence, Rhode Island
Yasser Y. El-Sayed
12   Stanford University, Stanford, California
Yoram Sorokin
13   Wayne State University, Detroit, Michigan
Steve N. Caritis
14   University of Pittsburgh, Pittsburgh, Pennsylvania
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network* › Institutsangaben


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. number, NCT01131260.

Precis: ST changes in fetal ECG, a marker of fetal cardiac hypoxia, occur more frequently in fetuses of diabetic parturients.

Key Points

  • Fetal hypertrophic cardiomyopathy (HCM) and cardiac dysfunction occur frequently among fetuses of diabetic patients.

  • Fetal ECG changes such as ST elevation and depression reflect cardiac hypoxia.

  • Fetuses of diabetic patients demonstrate a higher prevalence of fetal ECG tracings with ST changes.

* See Appendix for a list of other members of the NICHD MFMU Network


The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD34208, HD53097, HD40545, HD40560, HD27869, HD40485, HD40512, HD27915, HD40544, HD40500, HD68282, HD68268, HD27917, HD21410, HD36801] and by funding from Neoventa Medical. Comments and views expressed in this article are those of the authors and do not necessarily represent the views of the NICHD. Neoventa Medical did not participate in the monitoring of the study; data collection, management, or analysis; or manuscript preparation.

Presented in part at the Society for Maternal-Fetal Medicine's 39th Annual Pregnancy Meeting, February 11 to 16, 2019, Las Vegas, Nevada.


Eingereicht: 08. September 2021

Angenommen: 22. März 2022

Accepted Manuscript online:
05. April 2022

Artikel online veröffentlicht:
10. Juli 2022

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