Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Endocrinol (Lausanne). 2024 Aug 6;15:1403754. doi: 10.3389/fendo.2024.1403754. eCollection 2024.
For elective cesarean section patients with gestational diabetes mellitus (GDM), there is a lack of evidence-based research on the use of enhanced recovery after surgery (ERAS). This study aims to compare the ERAS after-surgery protocol and traditional perioperative management.
In this retrospective cohort study, singleton pregnancies with good glucose control GDM, delivered by elective cesarean sections under intravertebral anesthesia at least 37 weeks from January 1 to December 31, 2022, were collected at the Third Affiliated Hospital of Sun Yat-sen University. We divided all enrolled pregnant women and newborns into an ERAS group and a control group (the traditional perioperative management group) based on their adherence to the ERAS protocol. The primary outcome was the preoperative blood glucose level, with an increase of more than 1 mmol/L indicating clinical significance when compared to the control group. The secondary outcome was centered around an adverse composite outcome that affected both mothers and newborns.
We collected a total of 161 cases, with 82 in the ERAS group and 79 in the control group. Although the mean preoperative blood glucose level in the ERAS group was significantly higher than in the control group (5.01 ± 1.06 mmol/L vs. 4.45 ± 0.90 mmol/L, <0.001), the primary outcome revealed that the mean glycemic difference between the groups was 0.47 mmol/L (95% CI 0.15-0.80 mmol/L), which was below the clinically significant difference of 1 mmol/L. For the secondary outcomes, the ERAS group had an 86% lower risk of a composite adverse outcome compared to the control group. This included a 73% lower risk of perioperative maternal hypoglycemia and a 92% lower rate of neonatal hypoglycemia, all adjusted by age, hypertensive disorder of pregnancy, BMI, gestational weeks, primigravidae, primary pregnancy, GDM, surgery duration, and fasting glucose.
Implementing a low-dose carbohydrate ERAS in pregnant women with GDM prior to elective cesarean section, compared to traditional perioperative management, does not lead to clinically significant maternal glucose increases and thus glucose-related maternal or neonatal perioperative complications.
对于患有妊娠期糖尿病（GDM）的择期剖宫产患者，缺乏关于术后加速康复（ERAS）的循证研究。本研究旨在比较 ERAS 术后方案和传统围手术期管理。
本回顾性队列研究收集了 2022 年 1 月 1 日至 12 月 31 日期间在中山大学附属第三医院行椎管内麻醉下择期剖宫产且至少 37 周单胎妊娠、血糖控制良好的 GDM 孕妇及其新生儿。我们根据是否遵循 ERAS 方案将所有纳入的孕妇及其新生儿分为 ERAS 组和对照组（传统围手术期管理组）。主要结局是术前血糖水平，与对照组相比，增加超过 1mmol/L 具有临床意义。次要结局是围绕影响母婴的不良复合结局。
共收集了 161 例患者，其中 ERAS 组 82 例，对照组 79 例。尽管 ERAS 组的平均术前血糖水平显著高于对照组（5.01±1.06mmol/L 比 4.45±0.90mmol/L，<0.001），但主要结局显示两组之间的平均血糖差异为 0.47mmol/L（95%CI 0.15-0.80mmol/L），低于 1mmol/L 的临床显著差异。对于次要结局，与对照组相比，ERAS 组复合不良结局的风险降低了 86%。这包括围手术期产妇低血糖的风险降低了 73%，新生儿低血糖的发生率降低了 92%，均通过年龄、妊娠高血压疾病、BMI、孕周、初产妇、初产妇、GDM、手术时间和空腹血糖进行了调整。
与传统围手术期管理相比，在择期剖宫产前行 GDM 孕妇行低剂量碳水化合物 ERAS 方案并不会导致临床上显著的产妇血糖升高，因此不会导致与血糖相关的围手术期产妇或新生儿并发症。
