Maternal Diabetes and Intrapartum Fetal Electrocardiogram
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.
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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