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Ding T, Deng CM, Shen XF, Bai YW, Zhang XL, Liu JP, Yang LJ, Yu HT, Xie L, Chen H, Mu DL, Qu Y, Yang HX, Bao AR, Zhu SN, Wang DX: Effect of a carbohydrate-rich beverage on rate of cesarean delivery in primigravidae with epidural labor analgesia: a multicenter randomized trial. BMC Pregnancy Childbirth 2022; 22: 339

July 14, 2022

Background:
Labor represents a period of significant physical activity. Inefficient energy supply may delay labor pro‑ cess and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate‑rich beverage could reduce cesarean delivery in laboring women with epidural analgesia.
Methods:
This multicenter randomized trial was conducted in obstetrician‑led maternity units of nine tertiary hospi‑ tals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate‑rich beverage or commercially available low‑carbohydrate bev‑ erages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11‑point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth.
Results:
Between 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention‑to‑treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate‑rich beverage vs. 10.9% [106/971] with low‑carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate‑rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference − 1; 95% CI − 1 to 0; p < 0.01); their neonates had less hypoglycemia (1.0% [10/968] vs. 2.3% [22/956]; relative risk 0.45; 95% CI 0.21 to 0.94; p = 0.03) when compared with those in the low‑carbohydrate beverage group. They also had higher rates of maternal hyperglycemia (6.9% [67/965] vs. 1.9% [18/953]; p < 0.01) and neonatal hyperglycemia (9.2% [89/968] vs. 5.8% [55/956]; p < 0.01), but none required special treatment. Conclusions:
For laboring primigravidae with epidural analgesia, ingestion of a carbohydrate‑rich beverage com‑ pared with low‑carbohydrate beverages did not reduce cesarean delivery, but relieved maternal hunger and reduced neonatal hypoglycemia at the expense of increased hyperglycemia of both mothers and neonates. Optimal rate of carbohydrate supplementation remains to be determined.
Trial registration:: www. chictr. org. cn ;identifier: ChiCTR‑ IOR‑ 17011 994; registered on 14 July 2017.
Keywords:
Carbohydrate‑rich beverage, Epidural labor analgesia, Incidence of cesarean delivery, Neonatal hypoglycemia.