Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus

Petteri Hovi,Mikko Tarvonen,Kari Teramo,Sture Andersson,Piia Vuorela,Susanna Sainio

doi:10.1007/s00592-021-01756-0

Abstract

AimsIn previous reports, cardiotocographic (CTG) fetal heart rate (FHR) monitoring has shown only limited benefits in decreasing adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present study was to evaluate whether an association exists between the recently reported ZigZag pattern (FHR baseline amplitude changes of > 25 bpm with a duration of 2–30 min) and asphyxia-related neonatal outcomes in GDM pregnancies.MethodsIntrapartal CTGs were recorded in a one-year cohort of 5150 singleton childbirths. The following CTG changes were evaluated: ZigZag pattern, saltatory pattern, late decelerations, episodes of tachycardia and bradycardia, reduced variability, and uterine tachysystole. The cohort was divided into three groups: women with GDM, women with normal oral glucose tolerance test (OGTT), and women with no OGTT performed. Umbilical artery (UA) blood gases, Apgar scores, neonatal respiratory distress, and neonatal encephalopathy were used as outcome variables.ResultsGDM was diagnosed in 624 (12.1%), OGTT was normal in 4115 (79.9%), and OGTT was not performed in 411 (8.0%) women. Hypoxia-related ZigZag patterns (OR 1.94, 95% CI 1.64–2.34) and late decelerations (OR 1.65, 95% CI 1.27–2.13) of FHR, as well as a greater risk of fetal asphyxia (UA pH < 7.10 and/or UA BE < -12.0 meq/L and/or Apgar scores < 7 at 5-min) (OR 6.64, 95% CI 1.84–12.03) were observed in those with GDM compared with those without GDM.ConclusionsGDM is associated with intrapartal ZigZag pattern and late decelerations, cord blood acidemia and low 5-min Apgar scores at birth indicating increased occurrence of fetal hypoxia in GDM pregnancies.

Highlights

Gestational diabetes mellitus (GDM) is the most common medical disorder in pregnancy [1]
Fetuses with a ZigZag pattern had a higher risk of intrapartum fetal asphyxia (UA pH < 7.10 and/or Umbilical artery (UA) base excess (BE) < -12.0 meq/L and/or 5-min Apgar scores < 7) compared with cases without the pattern among women with GDM
Fasting hyperglycemia or an abnormal 2-h oral glucose tolerance test (OGTT) value correlated with the occurrence of ZigZag pattern, whereas no association was found between this fetal heart rate (FHR) pattern and an abnormal 1 h OGTT value

Summary

Introduction

Gestational diabetes mellitus (GDM) is the most common medical disorder in pregnancy [1]. Acta Diabetologica (2021) 58:1563–1573 in pregnancy, of which 84% were due to GDM [2]. GDM is increasing globally mainly as a result of increasing overweight and obesity in women of childbearing age [3]. In Finland, GDM was diagnosed in 19% of all childbirths in 2019 and in 25% of childbirths with maternal age 35 years or older [4]. A linear relationship has been found between fasting, 1-h and 2-h glucose values of the OGTT and perinatal complications [5]. An adequate treatment of GDM can lower the risk of perinatal complications to about the same level as for pregnancies without GDM [3, 5,6,7]

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