Perioperative carbohydrate loading improves comfort without adverse metabolic or neonatal effects in gestational diabetes mellitus

Description

Background Cesarean section is common among pregnant women with gestational diabetes mellitus (GDM), which affects approximately 14% of pregnancies and is characterized by dysregulated glycemia. Prolonged fasting before cesarean section is associated with discomfort and complications such as metabolic disorder, impaired postoperative recovery and neonatal hypoglycemia. Preoperative carbohydrate loading has been proposed as a strategy to overcome this issue, but there is a scarcity of evidence on its safety and benefits in GDM. This study aimed to evaluate the safety, efficacy, and metabolic impact of preoperative carbohydrate loading in pregnant women with GDM, compared with normoglycemic pregnant women. Methods Pregnant women with normoglycemia and GDM were classified into a fasting control (Normal-Fasting, n=45; GDM-Fasting, n=37) or a carbohydrate-loading (Normal-CHO, n=61; GDM-CHO, n=43) group according to their preoperative nutritional choice prior to cesarean delivery. Blood samples and clinical data were collected at admission (T1), one hour before surgery (T2), two hours after surgery (T3), and one day after surgery (T4). Maternal comfort scores based on self-reports and neonatal data were recorded. Metabolomic profiling was performed to explore underlying metabolic responses. Results In both the Normal (n=106) and GDM cohorts (n=80), perioperative carbohydrate loading significantly reduced thirst, hunger and anxiety compared with fasting controls. The Fasting and CHO groups showed no significant differences at any time point in terms of glycemic measures, inflammatory markers, or maternal and neonatal outcomes. Metabolomic analysis revealed distinct but partially overlapping alterations in metabolic pathways at T2 between the Normal and GDM groups. Conclusions Preoperative carbohydrate loading is safe and effective in alleviating preoperative discomfort in women with GDM undergoing cesarean delivery, without adversely affecting glycaemic control or neonatal outcomes. Metabolic differences between GDM and normoglycemic pregnancies suggest subtle, time-specific metabolic responses to carbohydrate intake.

Institutions

• Chongqing Medical University

  Chongqing, Chongqing

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