Oral Carbohydrate Administration was Suitable for Cesarean Section–A Systematic Review and Meta-Analysis of Randomized Trials

Ying Hu^1,2, Xiao Hong Song^3*, Li Bo Wang³, Zhi Qin Wang⁴, Zhen Feng Zhou⁵, Lin Jun Xu², Meng Yan Xu⁶ and Gui Juan He¹

¹School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China.

²Department of Surgery, Hangzhou Women’s Hospital (Hospital Maternity and Child Health Care Hospital), Hangzhou, China.

³Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou, China

⁴Department of Pharmacy, Zhejiang Provincial Xinhua Hospital, Hangzhou, China.

⁵Department of Anesthesiology, Hangzhou Women’s Hospital, Hangzhou, China,

⁶Department of Nursing Hangzhou Women’s Hospital, Hangzhou, China.

Corresponding Author E-mail: songxh8866@163.com

The use of carbohydrate (CHO) drinks prior to elective cesarean section has gained momentum, but its effect on maternal and neonatal outcomes remains controversial. The aim of this meta-analysis was to assess the effect of an oral CHO load prior to cesarean delivery on insulin sensitivity, insulin resistance, maternal glycemia, neonatal glycemia, and breastfeeding. As of May 21, 2023, we searched through five databases for English-language experimental studies on pre-cesarean oral CHO. A total of 3,940 citations were received, of which seven were selected. The concentrations of CHO used in these studies ranged from 5.9% to 14.2%, and the amounts used were 300-400 ml. We found that pre-cesarean CHO loading reduced maternal insulin resistance and increased maternal glucose levels. CHO loading activates the insulin pathway of critical en-zymes to some extent, increasing glucose utilization by peripheral tissues and ultimately reducing postop-erative insulin resistance. Of course, this is also beneficial in improving maternal blood sugar. We did not find that CHO increased maternal insulin sensitivity or neonatal blood glucose levels. Future prospective randomized controlled trials can use nutritional load to increase colostrum production after Caesarean sec-tion to enhance the confidence of these mothers in breastfeeding. In addition, our preoperative beverage could be more individualized to accommodate diabetic women.

Breastfeeding neonatal immunity; Cesarean section; Carbohydrate loading; Insulin resistance

[ HTML Full Text]