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

doi:10.1186/s12887-022-03170-z

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

BMC Pediatr. 2022 Mar 1;22(1):111. doi: 10.1186/s12887-022-03170-z.

Authors

Hailing Shao¹, Yehui Lan¹, Yiyu Qian¹, Ruyang Chen², Lingli Peng³, Ying Hua¹, Xiaomei Wang⁴

Affiliations

¹ Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, 325027, Wenzhou, China.
² Department of Obstetrics and Gynecology, Wenzhou Central Hospital, 325000, Wenzhou, China.
³ Department of Gynecology, Wenzhou People Hospital, 325000, Wenzhou, China.
⁴ Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, 325027, Wenzhou, China. wangxiaomei12321@163.com.

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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Constriction
Diabetes Mellitus*
Female
Fetal Blood* / metabolism
Glucose / metabolism
Hemoglobins / metabolism
Humans
Infant, Newborn
Lactic Acid / metabolism
Mothers
Prospective Studies
Umbilical Cord

Substances

Hemoglobins
Lactic Acid
Glucose

Associated data

ClinicalTrials.gov/NCT04369313