The Maternal and Neonatal Glycemic Stress Response in Normal Vaginal Delivery: A Comparative Study Between Epidural and Parenteral Opioids Analgesia.

BACKGROUND

It has been recognized that the type of anesthetic and analgesic technique and the relative pain degree may have an influence on hyperglycemic-stress response to surgery. This comparative study aimed to assess glucose levels in both mothers and infants during normal vaginal delivery. This study aimed to investigate this stress response between mothers who received parenteral analgesia versus epidural analgesia (EA) as an objective reflection for pain response.

METHODS

One hundred and seventeen patients participated in this prospective comparative study. They were categorized into two groups: parenteral analgesia group (who received subcutaneous morphine) and EA group. The primary outcome was to measure the difference in blood glucose level before delivery (at 3 cm cervical dilation), at full dilation, and at the third stage of labor and compare these values between both groups. The secondary outcome was to assess the factors affecting the glycemic stress response in mothers and neonates.

RESULTS

The change in maternal glucose level at full dilation and after delivery were significantly lower in the EA group. Neonatal glucose levels were not significantly different between the two groups. The change in maternal glucose level was influenced by the number of gravity and miscarriages. Neonatal glucose levels were associated with the gestational age of delivery, birth weight, and maternal glucose level at full cervical dilation.

CONCLUSION

EA appears superior to parenteral opioids analgesia, providing better pain management and subsequent lower stress response levels for mothers during vaginal delivery. These findings highlight the importance of the choice of analgesia during labor to optimize maternal well-being. Optimizing maternal factors (such as glycemic response) and neonatal factors (such as prematurity and birth weight) may influence the stress response of the neonates.