'Two-step' head-to-body delivery activates foetal gluconeogenesis

Area of Science:

• Obstetrics and Gynecology
• Neonatal Physiology
• Biochemistry

Background:

• The 'two-step' delivery method, involving delayed shoulder delivery, is associated with decreased umbilical artery pH in neonates.
• Fetal acidemia, a condition of low pH, may trigger specific metabolic responses.
• Understanding fetal metabolic adaptations during labor is crucial for neonatal well-being.

Purpose of the Study:

• To investigate whether fetal acidemia, indicated by low umbilical artery pH, activates fetal gluconeogenesis.
• To compare fetal glucose levels and pH in neonates delivered via different methods.

Main Methods:

• Umbilical cord blood glucose and pH were measured in 341 spontaneous 'two-step' vaginal deliveries (VD), 25 vacuum-assisted VD, 85 elective cesarean sections (CS), and 49 emergency CS.
• Statistical analyses were performed to compare glucose concentrations and pH values across delivery groups.

Main Results:

• Neonates from 'two-step' VD had significantly higher cord glucose (95.5 mg/dL vs 75.6 mg/dL) and lower pH (7.31 vs 7.33) compared to CS neonates.
• Vacuum-assisted VD neonates showed the highest glucose (101.4 mg/dL) and lowest pH (7.26).
• A significant negative correlation between cord glucose and pH was observed, particularly in vacuum-assisted VD.

Conclusions:

• Elevated cord blood glucose and decreased pH in 'two-step' VD neonates suggest activated fetal gluconeogenesis.
• These findings indicate a fetal metabolic response to acidemia during specific delivery methods.
• The study highlights potential implications for neonatal metabolic status based on delivery mode.