Barnes-Jewish Hospital | Washington University Physicians
breakthroughs from the lab


BY Kristina Sauerwein

Babies who suffer oxygen deficiencies during birth are at risk of brain damage that can lead to developmental delays, cerebral palsy and even death. To prevent this, most women in labor undergo continuous monitoring of the baby’s heart rate and receive supplemental oxygen if the heart rate is abnormal, with the thought that this common practice increases oxygen delivery to the baby. However, there is conflicting evidence about whether this long-recommended practice improves infant health.

Each year, 1.5 million women in the U.S.—two out of three pregnant women—receive supplemental oxygen at some point during childbirth.. Photo courtesy of Shutterstock

Recently, a research team conducted an analysis of 16 previous clinical trials of the practice and found no benefit in providing supplemental oxygen to mothers during labor and delivery. Infants born to women who received supplemental oxygen fared no better or no worse than those born to women who had similar labor experiences but breathed room air. The team was led by Washington University School of Medicine and involved scientists from Atrium Health Carolinas Medical Center in Charlotte, N.C.; the University of Texas at Austin; and Indiana University in Indianapolis.

Each year, 1.5 million women in the U.S.—two out of three pregnant women—receive supplemental oxygen at some point during childbirth, according to the researchers. The decades-long practice is recommended by the American College of Obstetricians and Gynecologists to treat abnormal fetal heart rates, which may indicate the baby’s oxygen levels are low and pose health risks.

“It is such a common practice because the thought is that by giving mom oxygen, we are increasing oxygen transfer to the baby,” says the study’s first author, Nandini Raghuraman, MD, MS, Washington University obstetrics and gynecology specialist at Barnes-Jewish Hospital. “However, the results of this study suggest that oxygen is not helpful in these cases and that the practice could be safely discontinued for many women.”

Raghuraman notes that supplemental oxygen is given mostly as a preventive measure, a practice that began during the 1960s. “Fetal monitoring can indicate a possible abnormal issue such as oxygen deprivation,” she says. “But about 80% of the time, women giving birth fall into an intermediate category, in which cases are not completely benign but also not high-risk. And in cases such as these, supplementing oxygen offers no additional benefits.”

Forgoing oxygen supplementation would help reduce an unnecessary intervention and likely reduce costs. “It’s been shown that moms, despite having health insurance, often incur steep out-of-pocket costs related to childbirth,” Raghuraman says. “Although oxygen is generally an inexpensive intervention compared with other labor and delivery services, minimizing any unnecessary procedure is important.”

At Barnes-Jewish Hospital, where Raghuraman delivers babies, the findings have begun to influence clinical care. “We’re being more judicious about giving supplemental oxygen to women during labor.”

Past studies have indicated that supplementing oxygen may be beneficial to women delivering via cesarean section; however, Raghuraman says more research is needed. “We also want to look at whether exposing mom and baby to prolonged oxygen during labor may be harmful,” she adds. “Outside of labor and delivery, a lot of research shows that over-oxygenation is associated with oxidative stress that can cause the kind of cellular damage that has been implicated in conditions such as cerebral palsy and Alzheimer’s disease. Our findings contradict a general myth that oxygen bars and other ways of increasing oxygen intake are healthy and helpful to a person’s overall well-being.”

The study’s findings were published Jan. 4 in JAMA Pediatrics.

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