Anesthesia type and its association with maternal stress-induced hyperglycemia during cesarean sections: a prospective cohort study, Silte Zone, central Ethiopia

Abstract Introduction Pregnancy is a form of stress, as it requires both physiological and biochemical adaptations in the body of a woman, and surgery may further increase the stress already experienced by the pregnant woman. Perioperative stress-induced hyperglycemia (SIH), which is common, occurs in up to 40% of critically ill patients and 32% of surgical patients with and without a history of diabetes. Perioperative hyperglycemia in surgery is linked to a 4-fold increase in complications and a 2-fold increase in death. Methods A hospital-based prospective cohort study was conducted on a total of 571 parturient who underwent cesarean delivery under anesthesia. Study participants were selected by systematic random sampling technique after proportional allocation to those selected hospitals. Data collection is from patient history, medical records, and blood glucose measurements. Blood glucose was measured four times during the procedure. Data were analyzed using STATA version 17. A linear mixed-effects model was used to compare glucose trajectories over time between groups, adjusting for potential confounders. Logistic regression was used to analyze the incidence of SIH. Result In our study, the incidence of stress-induced hyperglycemia in parturients undergoing cesarean section was 23.8%, with the GA group experiencing a greater incidence (31.7%) than the SA group (16.0%). There was a significant group-by-time interaction ( p = 0.008) after controlling for potential confounders, suggesting that the two groups’ glucose trajectories were different. At T2 (adjusted mean difference: 5.1 mg/dL; 95% CI: 1.8–8.4; p = 0.003) and T4 (adjusted mean difference: 4.2 mg/dL; 95% CI: 1.5–6.9; p = 0.002), general anesthesia was linked to considerably higher glucose levels. The adjusted odds ratio for SIH with GA compared to SA was 2.1 (95% CI: 1.4–3.2; p < 0.001). Conclusion In this prospective cohort, women undergoing general anesthesia had higher perioperative blood glucose measurements and a greater percentage of patients who met the study’s criteria for stress-induced hyperglycemia than women undergoing spinal anesthesia. However, these results should be interpreted as an association rather than proof of a causal influence of anesthetics technique, given the observational design, and the potential for residual confounding.