Supplemental Oxygen During Childbirth May Not Be of Value to Babies

By Megan Brooks

January 07, 2021

NEW YORK (Reuters Health) - There appears to be no benefit to providing supplemental oxygen to women during labor and delivery, according to a large meta-analysis.

"The results of this meta-analysis suggest that giving moms oxygen in response to the baby's heart rate may not be helpful and prolonged administration (for hours) should be avoided," Dr. Nandini Raghuraman of Washington University in St. Louis, Missouri, told Reuters Health by email.

"This analysis was prompted by mixed evidence for the use of oxygen in labor. Some studies showed benefit, others showed no benefit, and some even suggested this practice was harmful," she said.

The meta-analysis included 16 randomized clinical trials that compared the association of peripartum maternal oxygen administration with room air on umbilical artery (UA) gas measures and neonatal outcomes, with a total of 1,078 women in the oxygen group and 974 in the room-air group.

Compared with room air, maternal oxygen supplementation increased UA PaO2 significantly (weighted mean difference, 2.57 mm Hg) but did not influence UA pH (weighted mean difference, 0.00).

"The UA pH remained similar between the oxygen and room air groups even after accounting for risk of bias, use of low-flow devices, or FIO2 less than 60%," the researchers report. They also saw no significant between-group differences in other UA gas measures, rates of neonatal intensive-care unit admission, and Apgar scores.

"Although we looked at important outcomes such as the baby's pH, which tell us how much oxygen was getting to the baby, we did not have enough published research that looked at other relevant neonatal outcomes that are important for things like neurodevelopment," Dr. Raghuraman told Reuters Health by email.

"The studies we included in this analysis were also heterogeneous, meaning they were all designed differently and included different patient populations that may or may not benefit from oxygen," she noted.

"Oxygen is widely used so in order to de-implement it or remove it from current clinical practice we will need more research looking at the right patient population and more neonatal outcomes," she concluded.

"In the interim, prolonged oxygen use should be limited given lack of proven benefit and potential risk of harm. Future studies should also assess the optimal dose, duration, and route of peripartum oxygen administration," the authors conclude in their paper in JAMA Pediatrics.

The authors of a linked editorial say this "much-needed" review, coupled with lack of biologic plausibility of the benefits and an absence of data demonstrating any favorable impact "put the onus on advocates of maternal oxygen therapy to provide evidence of clinical benefit before claims of benefit."

"While maternal oxygen administration to the normally oxygenated mother in labor is likely as innocuous as it is useless, concern for the practice of evidence-based medicine would seem to suggest that recommendations for its use in 2 million to 3 million women annually may be inappropriate," Dr. Mohann Pammi from Texas Children's Hospital in Houston and co-authors say.

Weighing in on the results for Reuters Health, Dr. Elizabeth Greenstein Clement, Assistant Professor of Clinical Obstetrics and Gynecology at the Hospital of the University of Pennsylvania, said "Many women who have delivered at a hospital in the last few decades will recall their doctors and nurses giving them an oxygen mask during labor because of how the fetal heart tracing looked on the monitor."

"The thought was that by increasing oxygen to the mom, perhaps there would be improved oxygen to the baby in labor and that this could improve outcomes for the baby. This meta-analysis argues that there is no benefit to this established practice," Dr. Clement said by email.

"I think this paper is useful because oxygen in labor for potential fetal benefit is a widespread practice (endorsed by ACOG), and this can allow us to reevaluate if this is has any benefit. There still will be situations when oxygen in labor is beneficial, for example if the pregnant patient has low oxygen saturation," Dr. Clement said.

"This study is particularly relevant in the era of COVID, given some concern that giving supplemental oxygen could spread COVID around a room if a pregnant patient were COVID-positive, so knowing that there isn't a proven benefit may allow clinicians to feel more comfortable avoiding this longstanding practice," Dr. Clement added.

SOURCE: and JAMA Pediatrics, online January 4, 2021.