Effect of Oral Carbohydrate Intake During Labor on the Rate of Instrumental Vaginal Delivery: A Multicenter, Randomized Controlled Trial

Abstract

(Anesth Analg. 2020;30:1670–1677) Mendelson’s description of gastric fluid inhalation led to the practice of starving pregnant women during labor. Contrary to this practice, however, fluid consumption during labor has been shown to be safe and feasible. No definitive evidence exists to support food and fluid restriction during low-risk labors, unless a cesarean delivery (CD) becomes likely. In fact, the food and fluid restriction has been shown to create a shift toward the anaerobic pathway of glucose metabolism, despite a high glycogen content and turnover in the myometrium, thereby suggesting a relative energy shortage. This shortage may explain a commonly observed production of ketone bodies during labor, which results from fat metabolism following glycogen storage depletion. Ketosis during labor can be prevented by either allowing women in labor a light diet, or by allowing caloric intake via isotonic sports drinks. Ketosis and exhaustion can lead to a need for instrumental vaginal delivery when fatigue or inadequate progress develop during labor. The authors of this study hypothesized that carbohydrate intake, such as consuming isotonic sports drinks during labor, could reduce the instrumental vaginal delivery rate.