Effect of later cord clamping on umbilical cord blood gas in term neonates of diabetic mothers: a randomized clinical trial

Hailing Shao, Yehui Lan, Yiyu Qian, Ruyang Chen, Lingli Peng, Ying Hua, Xiaomei Wang, Hailing Shao, Yehui Lan, Yiyu Qian, Ruyang Chen, Lingli Peng, Ying Hua, Xiaomei Wang

Abstract

Objective: To evaluate the effect of later cord clamping (LCC) on umbilical arterial blood gas in neonates of diabetic mothers.

Methods: This prospective study included a group of 160 diabetic mothers (DM) whose neonates were randomized to immediate cord clamping (ICC) (≤ 15 s after birth) or LCC (≥ 30 s after birth), and a group of 208 non-diabetic mothers (NDM) whose neonates were randomized to ICC or LCC as a reference. Cord arterial pH, base excess (BE), bicarbonate (HCO3-), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), lactate, hemoglobin, hematocrit and glucose were compared among groups.

Results: In neonates of DM, there was no significant difference in cord arterial pH between the ICC and LCC group. LCC of ≥ 30 s decreased umbilical arterial HCO3- and BE and increased lactate (ICC versus LCC, HCO3-: 24.3 (22.7, 25.8) versus 23.7 (22.3, 24.7) mmol/L, P = 0.01; BE: -2.70 (-4.80, -1.50) versus - 3.72 (-5.66, -2.36) mmol/L, P = 0.006; lactate: 2.1 (1.6, 3.7) versus 2.7 (2.1, 4.3) mmol/L, P = 0.005), without the alterations of pCO2, pO2, hemoglobin, hematocrit and glucose. Similar results were found in neonates of NDM (ICC versus LCC, HCO3-: 24.3 (23.1, 25.7) versus 23.5 (22.3, 24.8) mmol/L, P = 0.01; BE: -2.39 (-3.73, -1.51) versus - 3.40 (-4.73, -1.91) mmol/L, P = 0.001; lactate: 2.2 (1.9, 3.3) versus 2.5 (2.0, 4.3) mmol/L, P = 0.01), except for the higher level of hemoglobin in the LCC group. The majority of diabetic mothers (ICC: 92.0%; LCC: 91.8%) had good blood glucose control. No differences were observed in acid-base status and glucose between neonates of DM and neonates of NDM in both ICC and LCC, but hemoglobin and hematocrit were elevated after ICC in neonates of DM compared to neonates of NDM.

Conclusions: Later cord clamping of ≥ 30 s resulted in a tendency towards metabolic acidosis of umbilical arterial blood in neonates of DM and NDM. Umbilical arterial blood gas parameters at birth were similar in neonates of DM and NDM.

Trial registration: ClinicalTrials.gov: NCT04369313 ; date of registration: 30/04/2020 (retrospectively registered).

Keywords: Diabetic pregnancy; Later cord clamping; Umbilical cord blood gas.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study flow chart

References

    1. Thorp JA, Dildy GA, Yeomans ER, Meyer BA, Parisi VM. Umbilical cord blood gas analysis at delivery. Am J Obstet Gynecol. 1996;175(3 Pt 1):517–22. doi: 10.1053/ob.1996.v175.a74401.
    1. Armstrong L, Stenson BJ. Use of umbilical cord blood gas analysis in the assessment of the newborn. Arch Dis Child Fetal Neonatal Ed. 2007;92(6):F430-4. doi: 10.1136/adc.2006.099846.
    1. Neilson JP. Umbilical cord blood gas analysis. BMJ. 2010;340:c1720. doi: 10.1136/bmj.c1720.
    1. Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy. Obstet Gynecol. 2014;123(4):896–901.
    1. Sabol BA, Caughey AB. Acidemia in neonates with a 5-minute Apgar score of 7 or greater - What are the outcomes? Am J Obstet Gynecol. 2016;215(4):486 e1-6. doi: 10.1016/j.ajog.2016.05.035.
    1. Committee Opinion No 684: Delayed Umbilical Cord Clamping After Birth. Obstet Gynecol. 2017;129(1):1.
    1. Wiberg N, Kallen K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG. 2008;115(6):697–703. doi: 10.1111/j.1471-0528.2008.01708.x.
    1. Valero J, Desantes D, Perales-Puchalt A, Rubio J, Diago Almela VJ, Perales A. Effect of delayed umbilical cord clamping on blood gas analysis. Eur J Obstet Gynecol Reprod Biol. 2012;162(1):21–3. doi: 10.1016/j.ejogrb.2012.01.020.
    1. Giovannini N, Crippa BL, Denaro E, Raffaeli G, Cortesi V, Consonni D, et al. The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean-delivered term newborns without fetal distress: a prospective observational study. BJOG. 2020;127(3):405–13. doi: 10.1111/1471-0528.16026.
    1. De Paco C, Florido J, Garrido MC, Prados S, Navarrete L. Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term. Archives of Gynecology and Obstetrics. 2011;283(5):1011–4. doi: 10.1007/s00404-010-1516-z.
    1. Andersson O, Hellstrom-Westas L, Andersson D, Clausen J, Domellof M. Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial. Acta Obstet Gynecol Scand. 2013;92(5):567–74. doi: 10.1111/j.1600-0412.2012.01530.x.
    1. De Paco C, Herrera J, Garcia C, Corbalan S, Arteaga A, Pertegal M, et al. Effects of delayed cord clamping on the third stage of labour, maternal haematological parameters and acid-base status in fetuses at term. Eur J Obstet Gynecol Reprod Biol. 2016;207:153–6. doi: 10.1016/j.ejogrb.2016.10.031.
    1. Mitanchez D, Yzydorczyk C, Siddeek B, Boubred F, Benahmed M, Simeoni U. The offspring of the diabetic mother–short- and long-term implications. Best Pract Res Clin Obstet Gynaecol. 2015;29(2):256–69. doi: 10.1016/j.bpobgyn.2014.08.004.
    1. Reif P, Panzitt T, Moser F, Resch B, Haas J, Lang U. Short-term neonatal outcome in diabetic versus non-diabetic pregnancies complicated by non-reassuring foetal heart rate tracings. J Matern Fetal Neonatal Med. 2013;26(15):1500–5. doi: 10.3109/14767058.2013.789845.
    1. Anderberg E, Kallen K, Berntorp K. The impact of gestational diabetes mellitus on pregnancy outcome comparing different cut-off criteria for abnormal glucose tolerance. Acta Obstet Gynecol Scand. 2010;89(12):1532–7. doi: 10.3109/00016349.2010.526186.
    1. Muche AA, Olayemi OO, Gete YK. Gestational diabetes mellitus increased the risk of adverse neonatal outcomes: A prospective cohort study in Northwest Ethiopia. Midwifery. 2020;87:102713. doi: 10.1016/j.midw.2020.102713.
    1. Riley RJ, Johnson JW. Collecting and analyzing cord blood gases. Clin Obstet Gynecol. 1993;36(1):13–23. doi: 10.1097/00003081-199303000-00005.
    1. Roberts SW, Leveno KJ, Sidawi JE, Lucas MJ, Kelly MA. Fetal acidemia associated with regional anesthesia for elective cesarean delivery. Obstet Gynecol. 1995;85(1):79–83. doi: 10.1016/0029-7844(94)P4401-9.
    1. Robson SC, Boys RJ, Rodeck C, Morgan B. Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth. 1992;68(1):54–9. doi: 10.1093/bja/68.1.54.
    1. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia. 2005;60(7):636–53. doi: 10.1111/j.1365-2044.2005.04223.x.
    1. Xodo S, Xodo L, Berghella V. Delayed cord clamping and cord gas analysis at birth. Acta Obstet Gynecol Scand. 2018;97(1):7–12. doi: 10.1111/aogs.13233.
    1. Mercer JS. Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Womens Health. 2001;46(6):402–14. doi: 10.1016/S1526-9523(01)00196-9.
    1. Bradley RJ, Brudenell JM, Nicolaides KH. Fetal acidosis and hyperlacticaemia diagnosed by cordocentesis in pregnancies complicated by maternal diabetes mellitus. Diabet Med. 1991;8(5):464–8. doi: 10.1111/j.1464-5491.1991.tb01633.x.
    1. Gluck L, Kulovich MV. Lecithin-sphingomyelin ratios in amniotic fluid in normal and abnormal pregnancy. Am J Obstet Gynecol. 1973;115(4):539–46. doi: 10.1016/0002-9378(73)90404-3.
    1. Nelson SM, Freeman DJ, Sattar N, Lindsay RS. Erythrocytosis in offspring of mothers with Type 1 diabetes–are factors other than insulin critical determinants? Diabet Med. 2009;26(9):887–92. doi: 10.1111/j.1464-5491.2009.02797.x.
    1. Hopfeld-Fogel A, Kasirer Y, Mimouni FB, Hammerman C, Bin-Nun A. Neonatal Polycythemia and Hypoglycemia in Newborns: Are They Related? Am J Perinatol. 2021;38(9):930–4.
    1. Rotshenker-Olshinka K, Shinwell ES, Juster-Reicher A, Rosin I, Flidel-Rimon O. Comparison of hematologic indices and markers of infection in umbilical cord and neonatal blood. J Matern Fetal Neonatal Med. 2014;27(6):625–8. doi: 10.3109/14767058.2013.825597.
    1. Metzger BE, Persson B, Lowe LP, Dyer AR, Cruickshank JK, Deerochanawong C, et al. Hyperglycemia and adverse pregnancy outcome study: neonatal glycemia. Pediatrics. 2010;126(6):e1545-52. doi: 10.1542/peds.2009-2257.

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