Pre-operative carbohydrate loading prior to elective caesarean delivery: a randomised controlled trial

Area of Science:

• Obstetrics and Gynecology
• Surgical Nutrition
• Metabolic Disorders

Background:

• Prolonged pre-operative fasting in women undergoing elective caesarean delivery can lead to a catabolic state.
• Pre-operative carbohydrate loading is established for major surgery but lacks robust evidence in caesarean delivery.

Purpose of the Study:

• To evaluate the impact of pre-operative carbohydrate drinks on urinary ketone presence in women undergoing elective caesarean section.
• To compare carbohydrate preloading against standard care (fasting) in this patient population.

Main Methods:

• A single-blind randomized controlled trial was conducted.
• 209 patients were randomized to either standard care or carbohydrate drinks.
• Urinary ketones were assessed immediately prior to surgery.

Main Results:

• The incidence of urinary ketones was significantly lower in the carbohydrate group (18.1%) compared to the standard care group (61.1%) (P<0.001).
• The number needed-to-treat to prevent urinary ketosis was three.
• No major adverse events were reported.

Conclusions:

• Pre-operative carbohydrate drinks are effective in reducing pre-operative ketosis in women undergoing elective caesarean delivery.
• This intervention supports optimizing patients before surgery by mitigating fasting effects.
• Generalizability may be limited by variations in institutional fasting protocols.