Delivery, maternal and neonatal outcomes in nulliparous women with gestational diabetes undergoing epidural labour analgesia: a propensity score-matched analysis

Objective This study aimed to retrospectively analyse the influence of epidural labour analgesia (ELA) on delivery and maternal and neonatal outcomes in nulliparous women with gestational diabetes mellitus (GDM) using propensity score-matched analysis. Design Retrospective cohort analysis. Setting Primary care practices in a teaching hospital from March 2018 to October 2021. Participants A total of 816 delivery records of nulliparous women with GDM were collected and retrospectively analysed. Interventions ELA and non-ELA (NELA) cohorts were assessed. Main outcome measure The primary outcome assessed was delivery type (spontaneous, assisted vaginal or caesarean). The secondary outcomes assessed included labour duration and maternal and neonatal outcomes. Results A total of 137 propensity score-matched pairs of ELA and NELA patients were analysed. ELA was associated with a decreased rate of caesarean section (18.3% vs 46.0% in the ELA vs NELA cohort, respectively; p<0.05) and an increased occurrence of assisted vaginal delivery (35.8% vs 12.4% in the ELA vs NELA cohort, respectively; p<0.05). The duration of the first and total stages of labour was prolonged, the occurrence of postpartum fever increased, and the duration of hospital stay was shortened in those receiving ELA (all p<0.05). Additionally, neonatal birth weight, plasma glucose levels and neonatal macrosomia occurrence increased, while neonatal intensive care unit admissions and neonatal hypoglycaemia decreased in the ELA versus the NELA group (all p<0.05). With respect to other maternal and neonatal outcomes, both cohorts were similar. Conclusions The use of ELA decreases the rate of caesarean section and improves maternal and neonatal outcomes in nulliparous women with GDM.

Automated summary

This study retrospectively analyzed the influence of epidural labour analgesia (ELA) on delivery and maternal and neonatal outcomes in nulliparous women with gestational diabetes mellitus (GDM) using propensity score-matched analysis. The results showed that ELA was associated with a decreased rate of caesarean section and an increased occurrence of assisted vaginal delivery. ELA was also found to prolong the duration of labor stages, increase the occurrence of postpartum fever, shorten hospital stay, and improve neonatal outcomes such as birth weight and plasma glucose levels.