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. 2021 Nov;58(11):1563-1573.
doi: 10.1007/s00592-021-01756-0. Epub 2021 Jun 21.

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

Mikko Tarvonen  1 , Petteri Hovi  2   3 , Susanna Sainio  4 , Piia Vuorela  5 , Sture Andersson  3 , Kari Teramo  6
Affiliations

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

Mikko Tarvonen et al. Acta Diabetol. 2021 Nov.

Abstract

Aims: In 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.

Methods: Intrapartal 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.

Results: GDM 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.

Conclusions: GDM 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.

Keywords: Birth cohort; Fetal asphyxia; Fetal heart rate; Gestational diabetes mellitus; Intrapartum cardiotocography; Perinatal outcome.

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Conflict of interest statement

The authors have no financial, personal, political, intellectual or religious interests to declare.

Figures

Fig. 1
Fig. 1
Flow chart of the study participants and grouping of the parturients according to the GDM present or absent or with no OGTT performed. CTG, Cardiotocography: OGTT, Oral glucose tolerance test
Fig. 2
Fig. 2
Intrapartum CTG recording at 41 + 1 weeks of pregnancy of a 36-year-old nullipara diagnosed with diet-treated GDM. At left, normal baseline FHR frequency (120 bpm/min) and normal variability followed by ZigZag pattern. A 17-min ZigZag episode is followed by repetitive late decelerations. The first stage of labor, cervix dilated 8 cm. No oxytocin augmentation was used. During the ZigZag pattern, no uterine hypertonus was observed, but the change of maternal position and movement of the abdominal toco transducer. A macrosomic male fetus, birth weight 4502 g, birth weight z-score + 2.1 SD, was born vaginally spontaneously 110 min after the occurrence of ZigZag pattern. Umbilical cord blood gas analysis showed acidemia: UA pH 7.05, UA BE -12.4 mmol/L, UA pO2 1.7 kPa. Apgar scores of 6 and 8 at 1 and 5 min, respectively. FHR was recorded via scalp electrode with paper speed 1 cm/min
See this image and copyright information in PMC

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