{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:45:54Z","timestamp":1789688754466,"version":"4.0.1"},"reference-count":43,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nutricia Polska Sp. z o.o.","award":["CRU\/1605\/2019\/Kw"],"award-info":[{"award-number":["CRU\/1605\/2019\/Kw"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare the effectiveness of CHO with standard fasting in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. Methods: A single-center, parallel, prospective randomized controlled trial (RCT) was conducted in a tertiary university obstetrics department at Pomeranian Medical University in Szczecin, Poland. Patients were randomly assigned (1:1 ratio) to the CHO group (oral carbohydrate 2 h before elective CD, n = 75) or the SF group (control\u2014standard fasting, n = 73). The main outcome measures were incidence and severity of PONV at 6 and 24 h after CD, time to the first peristalsis, time to first bowel movement, and biochemical parameters indicating ketosis in mothers and their children. Results: A total of 148 adult females with singleton pregnancies undergoing elective CD under spinal anesthesia (ASA I and II) were included in the final analysis. At 24 h after CD, 8.0% from the CHO group vs. 20.55% reported three or more episodes of vomiting or dry retching as compared to patients in the SF group (p = 0.041). Preoperative CHO supplementation decreased preoperative feelings of hunger (p &lt; 0.001) and thirst (p &lt; 0.001). Laboratory results in the CHO group showed higher plasma pH (p = 0.001) and glucose (p &lt; 0.001), lower F2-isoprostane in plasma (p = 0.049) and urine (p = 0.018), lower urine F2-isoprostane\/creatinine ratio (p = 0.045) than in the SF group. HOMA-IR (p &lt; 0.001) and lactate (p &lt; 0.001) were higher in the CHO group than in the control group. Conclusions: There was no significant difference in the incidence or severity of early PONV at 6 h. The incidence of vomiting or dry retching at 24 h after cesarean delivery was lower in the CHO group as compared to standard starvation, but the combined results of PONV frequency and severity on the Wengritzky scale did not differ between the two study groups. Preoperative CHO supplementation decreased preoperative feelings of hunger and thirst, enhancing the comfort of pregnant women. Trial registration: ClinicalTrials.gov identifier: NCT04069806.<\/jats:p>","DOI":"10.3390\/jcm12154978","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T02:13:32Z","timestamp":1690769612000},"page":"4978","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery under Spinal Anaesthesia\u2014A Randomized Controlled Trial"],"prefix":"10.3390","volume":"12","author":[{"given":"Katarzyna","family":"Kotfis","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arleta","family":"Wojciechowska","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u0142gorzata","family":"Zimny","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0203-1823","authenticated-orcid":false,"given":"Dominika","family":"Jamio\u0142-Milc","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6105-5329","authenticated-orcid":false,"given":"Aleksandra","family":"Szyli\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kwiatkowski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Kaim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3138-1013","authenticated-orcid":false,"given":"Barbara","family":"Do\u0142\u0119gowska","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4009-1977","authenticated-orcid":false,"given":"Ewa","family":"Stachowska","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Zukowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6016-0176","authenticated-orcid":false,"given":"Maria","family":"Pankowiak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Torb\u00e9","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Wischmeyer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2147\/LRA.S111459","article-title":"Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: Challenges and solutions","volume":"10","author":"Jelting","year":"2017","journal-title":"Local Reg. Anesth."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.ijoa.2004.12.004","article-title":"Intraoperative nausea and vomiting during cesarean section under regional anesthesia","volume":"14","author":"Balki","year":"2005","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"81","DOI":"10.5114\/ait.2019.86166","article-title":"Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics","volume":"51","author":"Batova","year":"2019","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"993","DOI":"10.12659\/MSM.889597","article-title":"Prophylaxis of intra and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia","volume":"19","author":"Voigt","year":"2013","journal-title":"Med. Sci. Monit."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0002-9378(16)39829-5","article-title":"The aspiration of stomach contents into the lungs during obstetric anesthesia","volume":"52","author":"Mendelson","year":"1946","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.bpa.2006.02.001","article-title":"Fasting from midnight: The history behind the dogma","volume":"20","author":"Maltby","year":"2006","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"125","DOI":"10.5114\/ait.2019.85953","article-title":"Relationship between the regurgitated and the aspirated volume of water. A manikin study","volume":"51","author":"Bouvet","year":"2019","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5603\/AIT.2016.0006","article-title":"Anaesthetic perioperative management according to the enhanced recovery after surgery protocol","volume":"48","author":"Horosz","year":"2016","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_9","first-page":"CD004423","article-title":"Preoperative fasting for adults to prevent perioperative complications","volume":"4","author":"Brady","year":"2003","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s00404-020-05455-z","article-title":"Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: A randomized interventional study","volume":"301","author":"Wendling","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.bpa.2006.02.004","article-title":"The metabolic effects of fasting and surgery","volume":"20","author":"Nygren","year":"2006","journal-title":"Best. Pract. Res. Clin. Anaesthesiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.clnu.2009.04.014","article-title":"Short-term starvation and mitochondrial dysfunction\u2014a possible mechanism leading to postoperative insulin resistance","volume":"28","author":"Awad","year":"2009","journal-title":"Clin. Nutr."},{"key":"ref_13","first-page":"CD004230","article-title":"Interventions for ketosis in labour","volume":"3","author":"Toohill","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/EJA.0b013e3283495ba1","article-title":"European Society of Anaesthesiology. Perioperative fasting in adults and children: Guidelines from the European Society of Anaesthesiology","volume":"28","author":"Smith","year":"2011","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"American Society of Anesthesiologists (2011). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology, 114, 495\u2013511.","DOI":"10.1097\/ALN.0b013e3181fcbfd9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1177\/0148607114567713","article-title":"Practice guideline recommendations on perioperative fasting: A systematic review","volume":"40","author":"Lambert","year":"2016","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"523.e1","DOI":"10.1016\/j.ajog.2018.09.015","article-title":"Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)","volume":"219","author":"Wilson","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","first-page":"CD009161","article-title":"Preoperative carbohydrate treatment for enhancing recovery after elective surgery","volume":"8","author":"Smith","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.bja.2019.11.036","article-title":"Two hours too long: Time to review fasting guidelines for clear fluids","volume":"17","author":"Morrison","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kotfis, K., Jamio\u0142-Milc, D., Skonieczna-\u017bydecka, K., Folwarski, M., and Stachowska, E. (2020). The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients, 12.","DOI":"10.3390\/nu12103105"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"b784","DOI":"10.1136\/bmj.b784","article-title":"Effect of food intake during labour on obstetric outcome: Randomised controlled trial","volume":"338","author":"Liu","year":"2009","journal-title":"BMJ"},{"key":"ref_22","first-page":"59","article-title":"Effect of oral carbohydrate intake on labor progress: Randomized controlled trial","volume":"41","author":"Rahmani","year":"2012","journal-title":"Iran. J. Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1515\/JPM.2002.062","article-title":"The effects of oral carbohydrate administration on fetal acid base balance","volume":"30","author":"Scheepers","year":"2002","journal-title":"J. Perinat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1111\/1471-0528.13728","article-title":"Does oral carbohydrate supplementation improve labour outcome? A systematic review and individual patient data meta-analysis","volume":"123","author":"Malin","year":"2016","journal-title":"BJOG"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ijoa.2020.10.008","article-title":"Pre-operative carbohydrate loading prior to elective caesarean delivery: A randomised controlled trial","volume":"45","author":"Clark","year":"2021","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_26","first-page":"280","article-title":"Incidence of urinary ketosis and the effect of carbohydrate drink supplementation during fasting for elective caesarean section: Audit","volume":"32","author":"Bellwood","year":"2022","journal-title":"J. Perioper. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.clnu.2012.10.011","article-title":"A meta-analysis of randomized controlled trials on preoperative oral carbohydrate treatment in elective surgery","volume":"32","author":"Awad","year":"2013","journal-title":"Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"802924","DOI":"10.1155\/2012\/802924","article-title":"Impact of ramadan intermittent fasting on oxidative stress measured by urinary 15-f(2t)-isoprostane","volume":"2012","author":"Faris","year":"2012","journal-title":"J. Nutr. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1016\/j.clinbiochem.2007.09.004","article-title":"Plasma levels of 15-F(2t)-isoprostane in newborn infants are affected by mode of delivery","volume":"40","author":"Greco","year":"2007","journal-title":"Clin. Biochem."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jopan.2020.05.006","article-title":"Effect of Preoperative Oral Carbohydrate Administration on Patients Undergoing Cesarean Section with Epidural Anesthesia: A Pilot Study","volume":"36","author":"Shi","year":"2021","journal-title":"J. Perianesth. Nurs."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"He, Y., Liu, C., Han, Y., Huang, Y., Zhou, J., and Xie, Q. (2021). The impact of oral carbohydrate-rich supplement taken two hours before caesarean delivery on maternal and neonatal perioperative outcomes\u2014A randomized clinical trial. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04155-z"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1308\/003588414X13824511650614","article-title":"Role of preoperative carbohydrate loading: A systematic review","volume":"96","author":"Bilku","year":"2014","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_33","first-page":"19","article-title":"Insulin and insulin resistance","volume":"26","author":"Wilcox","year":"2005","journal-title":"Clin. Biochem. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s12020-021-02868-x","article-title":"Association between new markers of cardiovascular risk and hepatic insulin resistance in those at high risk of developing type 2 diabetes","volume":"75","author":"Monti","year":"2022","journal-title":"Endocrine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/jcb.26174","article-title":"Tumor Necrosis Factor-Alpha: Role in Development of Insulin Resistance and Pathogenesis of Type 2 Diabetes Mellitus","volume":"119","author":"Akash","year":"2018","journal-title":"J. Cell. Biochem."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3577","DOI":"10.1002\/jcb.26097","article-title":"Mechanism of Generation of Oxidative Stress and Pathophysiology of Type 2 Diabetes Mellitus: How Are They Interlinked?","volume":"118","author":"Rehman","year":"2017","journal-title":"J. Cell. Biochem."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e734","DOI":"10.1210\/clinem\/dgab655","article-title":"Rate of Gestational Weight Gain and Glucose-Insulin Metabolism Among Hispanic Pregnant Women With Overweight and Obesity","volume":"107","author":"Lindsay","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"705424","DOI":"10.3389\/fphys.2021.705424","article-title":"Diabetes and Heart Failure: Multi-Omics Approaches","volume":"12","author":"Roudsari","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"47","DOI":"10.5114\/ait.2020.92967","article-title":"Readmission to hospital following laparoscopic cholecystectomy: A meta-analysis","volume":"52","author":"McIntyre","year":"2020","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1080\/19390211.2017.1353566","article-title":"The Effect of Preoperative Oral Carbohydrate on Breastfeeding After Cesarean Section: A Double-Blind, Randomized Controlled Clinical Trial","volume":"15","author":"Fard","year":"2018","journal-title":"J. Diet. Suppl."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnesp.2021.08.023","article-title":"Preoperative carbohydrate loading in surgical patients with type 2 diabetes: Are concerns supported by data?","volume":"45","author":"Robinson","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1007\/s00268-017-4413-9","article-title":"The use of a preoperative carbohydrate drink in patients with diabetes mellitus: A prospective, non-inferiority, cohort study","volume":"42","author":"Lafflin","year":"2018","journal-title":"World J. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1111\/jog.14653","article-title":"Safety, and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial","volume":"47","author":"Liu","year":"2021","journal-title":"J. Obstet. Gynaecol. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/15\/4978\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:21:45Z","timestamp":1760127705000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/15\/4978"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,28]]},"references-count":43,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["jcm12154978"],"URL":"https:\/\/doi.org\/10.3390\/jcm12154978","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,28]]}}}