Maternal Diabetes and Intrapartum Fetal Electrocardiogram

Authors

Beth A Plunkett
Steven J Weiner
George R Saade
Michael A Belfort
Sean C Blackwell
John M Thorp
Alan T N Tita
Russell S Miller
David S McKenna
Edward K S Chien
Dwight J Rouse
Yasser Y El-Sayed
Yoram Sorokin
Steve N Caritis
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

Publication Date

5-1-2024

Journal

American Journal of Perinatology Reports

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:

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.

Keywords

Humans, Female, Pregnancy, Diabetes, Gestational, Electrocardiography, Adult, Pregnancy in Diabetics, Labor Stage, First, Labor Stage, Second, Fetal Hypoxia, Cardiotocography, maternal diabetes, fetal heart, fetal electrocardiogram

Comments

ClinicalTrials.gov number, NCT01131260

PMID: 35381609