Does oral carbohydrate supplementation improve labour outcome? A systematic review and individual patient data meta-analysis.

BACKGROUND: Labour is a period of significant physical activity. The importance of carbohydrate intake to improve outcome has been recognised in sports medicine and general surgery.

OBJECTIVES: To assess the effect of oral carbohydrate supplementation on labour outcomes.

SEARCH STRATEGY: MEDLINE (1966-2014), Embase, the Cochrane Library and clinical trial registries.

SELECTION CRITERIA: Randomised controlled trials (RCT) of women randomised to receive oral carbohydrate in labour (<6 cm dilated), versus placebo or standard care.

DATA COLLECTION AND ANALYSIS: Authors were contacted to provide data. Individual patient data meta-analyses were performed to calculate pooled risk ratios (RR) and 95% confidence intervals (CI).

MAIN RESULTS: Eight RCTs met the inclusion criteria. Six authors responded, four supplied data (n = 691). Three studies used isotonic drinks (one placebo-controlled, two compared with standard care), and one an advice booklet regarding carbohydrate intake. The mean difference in energy intake between the intervention and control groups was small [three studies, 195 kilocalories (kcal), 95% CI 118-273]. There was no difference in the risk of caesarean section (RR 1.15, 95% CI 0.83- 1.61), instrumental birth (RR 1.26, 95% CI 0.96-1.66) or syntocinon augmentation (RR 0.99, 95% CI 0.86-1.13). Length of labour was similar (mean difference -3.15 minutes, 95% CI -35.14 to 41.95). Restricting the analysis to primigravid women did not affect the result. Oral carbohydrates did not increase the risk of vomiting (RR 1.09, 95% CI 0.78-1.52) or 1-minute Apgar score <7 (RR 1.23, 95% CI 0.82-1.83).

AUTHORS' CONCLUSION: Oral carbohydrate supplements in small quantities did not alter labour outcome.

TWEETABLE ABSTRACT: Oral carbohydrate does not affect labour. But the difference between intervention and control equals 10 teaspoons sugar.