Type of Anesthesia and the Impact of Labor Epidural Analgesia on Glucose Levels in Cesarean Section and Neonatal Outcomes: A Systematic Review and Meta-Analysis

Considering the sensitivity of blood glucose level of mother and baby at the time of birth, the present study was conducted with aim to investigate the effect of the type of anesthesia (general, spinal, epidural) on blood glucose level after surgery and neonatal outcomes in pregnant women with gestational diabetes.

In this systematic review and meta-analysis study, databases of PubMed, Scopus, Web of Science, SID, and Megiran were searched using a combination of keywords of cesarean section, type of anesthesia, blood glucose level, and gestational diabetes without time limit. Studies were included that examined the effects of types of anesthesia such as general anesthesia, spinal anesthesia, and epidural anesthesia on blood glucose levels, maternal stress response, opioid use, and neonatal outcomes.

Postoperative blood glucose levels in spinal anesthesia were significantly lower than general anesthesia (random effect model; I2=99%). Removing publication bias using the Trim and Fill method led to adjusted results that did not show statistical or clinical differences in blood glucose levels. There was no difference in NICU admission and neonatal hypoglycemia. The quality of evidence in most studies was very low.

There was no difference between general and spinal anesthesia in glycemic control outcome. These results emphasize the importance of choosing the type of anesthesia and monitoring during surgery in specific clinical scenarios.