A Cochrane review [Abstract] 1 included 5 studies with a total of 3130 subjects. All women were at low risk of potentially requiring a general anaesthesia. The comparisons were complete restriction vs freedom to eat and drink in 1 trial, water only vs specific fluids and foods in 2 trials, and water only vs carbohydrate drinks in 2 trials. When comparing any restriction of fluids and food vs some nutrition during active labour, the meta-analysis was dominated by one study undertaken in a highly medicalised environment (n=2400). There were no statistically significant differences in caesarean section (average risk ratio (RR) 0.89, 95% CI 0.63 to 1.25; 5 studies, n=3103), operative vaginal births (average RR 0.98, 95% CI 0.88 to 1.10; 5 studies, n=3103) and Apgar scores less than 7 at five minutes (average RR 1.43, 95% CI 0.77 to 2.68; 3 studies, n=2574), nor in any of the other outcomes assessed. Women's views were not assessed. No women suffered from regurgitation during general anaesthesia. However, the data were insufficient to assess the incidence of Mendelson's syndrome, an extremely rare outcome (increased risk of the stomach contents entering the lungs during general anaesthesia). Other comparisons showed similar findings, except an increased risk of caesarean sections in one study (n=88) for women taking carbohydrate drinks compared with water only.
A meta-analysis 2 included 10 trials with a total of 3 982women. All the studies involved laboring singletons considered at low risk fo caesarean section. In 3 studies, women were allowed to select from a low-residue diet throughout the course of labor. One study had honey date syrup as the allowed food intake. 5 studies had carbohydrate drinks as food intake in labor. The last one was the only trial that allowed unrestrictive food intake. In the included studies, all women in the intervention group were allowed the assigned food intake until delivery, whereas women in a control group were allowed only ice chips, water, or sips of water until delivery. A policy of less-restrictive food intake was associated with a significantly shorter duration of labor (mean difference -16 minutes, 95% CI -25 to -7). No other benefits or harms in obstetric or neonatal outcome were noticed. Regurgitation during general anesthesia and Mendelson syndrome did not occur in either group.
Comment: The quality of evidence is downgraded by study quality (lack of blinding of mothers and midwives, in the dominating trial 20 % in the water group ate and 29 % in the food group did not eat), and by imprecise results for aspiration pneumonia.
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