{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T22:43:42Z","timestamp":1747694622836,"version":"3.37.3"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"S 01","funder":[{"name":"Neoventa Medical"},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["HD21410,HD27869,HD27915,HD27917,HD34208,HD36801,HD40485,HD40500,HD40512,HD40544,HD40545,HD40560,HD53097,HD68268,HD68282"],"award-info":[{"award-number":["HD21410,HD27869,HD27915,HD27917,HD34208,HD36801,HD40485,HD40500,HD40512,HD40544,HD40545,HD40560,HD53097,HD68268,HD68282"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003Fetal electrocardiogram (ECG) ST changes are associated with fetal cardiac hypoxia. Our objective was to evaluate ST changes by maternal diabetic status and stage of labor.<\/jats:p><jats:p>\n            Methods\u2003This was a secondary analysis of a multicentered randomized-controlled trial in which laboring patients with singleton gestations underwent fetal ECG scalp electrode placement and were randomly assigned to masked or unmasked ST-segment readings. Our primary outcome was the frequency of fetal ECG tracings with ST changes by the stage of labor. ECG tracings were categorized into mutually exclusive groups (ST depression, ST elevation without ST depression, or no ST changes). We compared participants with DM, gestational diabetes mellitus (GDM), and no DM.<\/jats:p><jats:p>\n            Results\u2003Of the 5,436 eligible individuals in the first stage of labor (95 with pregestational DM and 370 with GDM), 4,427 progressed to the second stage. ST depression occurred more frequently in the first stage of labor in participants with pregestational DM (15%, adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.14\u20134.24) and with GDM (9.5%, aOR 1.51, 95% CI 1.02\u20132.25) as compared with participants without DM (5.7%). The frequency of ST elevation was similar in participants with pregestational DM (33%, aOR 0.79, 95% CI 0.48\u20131.30) and GDM (33.2%, aOR 0.91, 95% CI 0.71\u20131.17) as compared with those without DM (34.2%). In the second stage, ST depression did not occur in participants with pregestational DM (0%) and occurred more frequently in participants with GDM (3.5%, aOR 2.01, 95% CI 1.02\u20133.98) as compared with those without DM (2.0%). ST elevation occurred more frequently in participants with pregestational DM (30%, aOR 1.81, 95% CI 1.02\u20133.22) but not with GDM (19.0%, aOR 1.06, 95% CI 0.77\u20131.47) as compared with those without DM (17.8%).<\/jats:p><jats:p>\n            Conclusion\u2003ST changes in fetal ECG occur more frequently in fetuses of diabetic mothers during labor. ClinicalTrials.gov number, NCT01131260.<\/jats:p><jats:p>\n            Precis:\u2003ST changes in fetal ECG, a marker of fetal cardiac hypoxia, occur more frequently in fetuses of diabetic parturients.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1817-5788","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T22:58:25Z","timestamp":1649199505000},"page":"e14-e21","source":"Crossref","is-referenced-by-count":2,"special_numbering":"S","title":["Maternal Diabetes and Intrapartum Fetal Electrocardiogram"],"prefix":"10.1055","volume":"41","clinical-trial-number":[{"clinical-trial-number":"nct01131260","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1712-2226","authenticated-orcid":false,"given":"Beth A.","family":"Plunkett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Weiner","sequence":"additional","affiliation":[{"name":"the George Washington University Biostatistics Center, Washington, Dist. Of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George R.","family":"Saade","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, Galveston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Belfort","sequence":"additional","affiliation":[{"name":"University of Utah Health Sciences Center, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean C.","family":"Blackwell","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"John M.","family":"Thorp","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan T. N.","family":"Tita","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell S.","family":"Miller","sequence":"additional","affiliation":[{"name":"Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S.","family":"McKenna","sequence":"additional","affiliation":[{"name":"The Ohio State University, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward K. S.","family":"Chien","sequence":"additional","affiliation":[{"name":"MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dwight J.","family":"Rouse","sequence":"additional","affiliation":[{"name":"Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasser Y.","family":"El-Sayed","sequence":"additional","affiliation":[{"name":"Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoram","family":"Sorokin","sequence":"additional","affiliation":[{"name":"Wayne State University, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve N.","family":"Caritis","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network*","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,7,10]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1748-1716.1981.tb06853.x","article-title":"Myocardial metabolism in relation to electrocardiographic changes and cardiac function during graded hypoxia in the fetal lamb","volume":"113","author":"K H H\u00f6keg\u00e5rd","year":"1981","journal-title":"Acta Physiol Scand"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1067\/mob.2001.111932","article-title":"ST waveform changes during repeated umbilical cord occlusions in near-term fetal sheep","volume":"184","author":"J A Westgate","year":"2001","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/j.1748-1716.1979.tb06331.x","article-title":"ECG-changes in the fetal lamb during asphyxia in relation to beta-adrenoceptor stimulation and blockade","volume":"105","author":"K H H\u00f6keg\u00e5rd","year":"1979","journal-title":"Acta Physiol Scand"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"411","DOI":"10.3109\/00016348009155419","article-title":"Alterations in the electrocardiogram of the fetal lamb as a sign of fetal asphyxia. A comparison between the scalp lead and the precordial lead","volume":"59","author":"K H H\u00f6keg\u00e5rd","year":"1980","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1748-1716.1976.tb10312.x","article-title":"A study of the relationship between the electrocardiogram and hemodynamics in the fetal lamb during asphyxia","volume":"98","author":"K G Ros\u00e9n","year":"1976","journal-title":"Acta Physiol Scand"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/0140-6736(92)90465-F","article-title":"Randomised trial of cardiotocography alone or with ST waveform analysis for intrapartum monitoring","volume":"340","author":"J Westgate","year":"1992","journal-title":"Lancet"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/j.1471-0528.2006.00886.x","article-title":"A comparison of intrapartum automated fetal electrocardiography and conventional cardiotocography\u2014a randomised controlled study","volume":"113","author":"K Ojala","year":"2006","journal-title":"BJOG"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"299.e1","DOI":"10.1016\/j.ajog.2007.07.007","article-title":"A French randomized controlled trial of ST-segment analysis in a population with abnormal cardiotocograms during labor","volume":"197","author":"C Vayssi\u00e8re","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1097\/AOG.0b013e3181dfffd6","article-title":"Cardiotocography plus ST analysis of fetal electrocardiogram compared with cardiotocography only for intrapartum monitoring: a randomized controlled trial","volume":"115","author":"M EMH Westerhuis","year":"2010","journal-title":"Obstet Gynecol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/S0140-6736(01)05703-8","article-title":"Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial","volume":"358","author":"I Amer-W\u00e5hlin","year":"2001","journal-title":"Lancet"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1056\/NEJMoa1500600","article-title":"A Randomized trial of intrapartum fetal ECG ST-segment analysis","volume":"373","author":"M A Belfort","year":"2015","journal-title":"N Engl J Med"},{"issue":"06","key":"ref12","first-page":"389","article-title":"[Natural history of myocardial hypertrophy and its association with hyperinsulinism in infants of diabetic mothers]","volume":"69","author":"P Zielinsky","year":"1997","journal-title":"Arq Bras Cardiol"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00246-003-0538-8","article-title":"Congenital heart disease in infants of diabetic mothers: echocardiographic study","volume":"25","author":"R M Abu-Sulaiman","year":"2004","journal-title":"Pediatr Cardiol"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1399-5448.2011.00811.x","article-title":"Infants of diabetic mothers: echocardiographic measurements and cord blood IGF-I and IGFBP-1","volume":"13","author":"M M El-Ganzoury","year":"2012","journal-title":"Pediatr Diabetes"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"290.e1","DOI":"10.1016\/j.ajog.2014.05.011","article-title":"Elevated neonatal insulin-like growth factor I is associated with fetal hypertrophic cardiomyopathy in diabetic women","volume":"211","author":"A B Gonzalez","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1177\/000992288602500507","article-title":"Maternal diabetic control and hypertrophic cardiomyopathy in infants of diabetic mothers","volume":"25","author":"P Q Sheehan","year":"1986","journal-title":"Clin Pediatr (Phila)"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/jog.13174","article-title":"Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus","volume":"43","author":"C Y Sanhal","year":"2017","journal-title":"J Obstet Gynaecol Res"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/s-0037-1598602","article-title":"Prevalence of hypertrophic cardiomyopathy in fetuses of mothers with gestational diabetes before initiating treatment","volume":"39","author":"C R Palmieri","year":"2017","journal-title":"Rev Bras Ginecol Obstet"},{"issue":"02","key":"ref19","first-page":"103","article-title":"Cardiovascular malformations in infants of diabetic mothers: a retrospective case-control study","volume":"55","author":"P Akbariasbagh","year":"2017","journal-title":"Acta Med Iran"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"564316","DOI":"10.1155\/2011\/564316","article-title":"Cardiac function in 7-8-year-old offspring of women with type 1 diabetes","volume":"2011","author":"M Rijpert","year":"2011","journal-title":"Exp Diabetes Res"},{"key":"ref21","first-page":"925","article-title":"Fatal hypertrophic cardiomyopathy in the fetus of a woman with diabetes","volume":"98","author":"M G Sardesai","year":"2001","journal-title":"Obstet Gynecol"},{"issue":"08","key":"ref22","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.2337\/diacare.28.8.2084","article-title":"Acute presentation of fetal hypertrophic cardiomyopathy in a type 1 diabetic pregnancy","volume":"28","author":"F Prefumo","year":"2005","journal-title":"Diabetes Care"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s13256-017-1231-5","article-title":"Three patients presenting with severe macrosomia and congenital hypertrophic cardiomyopathy: a case series","volume":"11","author":"M Vincent","year":"2017","journal-title":"J Med Case Reports"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/14767050801924431","article-title":"Intrapartum fetal ECG and diabetes","volume":"21","author":"B M Yli","year":"2008","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/j.0001-6349.2005.00594.x","article-title":"Electrocardiographic changes following umbilical cord occlusion in the midgestation fetal sheep","volume":"84","author":"A K Welin","year":"2005","journal-title":"Acta Obstet Gynecol Scand"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1817-5788.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:05:33Z","timestamp":1730811933000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1817-5788"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,5]]},"references-count":25,"journal-issue":{"issue":"S 01","published-online":{"date-parts":[[2024,5,13]]},"published-print":{"date-parts":[[2024,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1817-5788","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published-other":{"date-parts":[[2022,4,5]]},"published":{"date-parts":[[2022,4,5]]}}}