Objective To analyze the effects of preoperative oral carbohydrate (CHO) drinks on enhanced recovery after elective cesarean section in women with diabetes and neonatal outcomes, and to explore the application value and safety of preoperative oral CHO drinks.

Methods A retrospective study was conducted on 244 diabetic puerpera who underwent elective lower-segment transverse cesarean section at the Obstetrics and Gynecology Hospital of Fudan University from May 2024 to April 2026. According to whether CHO drinks were orally administered preoperatively, the participants were divided into the CHO group and the control group. The incidence rates of perioperative hypoglycemia, hyperglycemia, and vomiting, preoperative fluid supplementation, postoperative 2 h hunger and thirst scores, postoperative 2 d pain score, as well as satisfaction score regarding the fasting regimen were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify factors associated with neonatal hypoglycemia and hospitalization within 48 h.

Results Compared with the control group, the proportion of puerpera requiring preoperative fluid supplementation was lower in the CHO group (0.83% vs 8.06%, P＝0.006), postoperative 2 h thirst scores (2.15±1.29 vs 2.93±1.67, P＜0.001) and hunger scores (1.33±1.06 vs 1.94±1.38, P＜0.001) were lower, and satisfaction scores regarding the fasting regimen were higher (7.78±1.22 vs 6.73±1.47, P＜0.001). There were no statistically significant differences between the two groups in the incidence of perioperative hyperglycemia, hypoglycemia, vomiting, postoperative flatus time, or pain scores. Neonatal blood glucose level in the observation room was lower in the CHO group than in the control group (3.23±0.77 mmol/L vs 3.38±0.63 mmol/L, P＝0.045), and the incidence of neonatal hypoglycemia was significantly higher in the CHO group (19.17% vs 2.42%, P＜0.001). Multivariate logistic regression analysis showed that preoperative oral CHO drinks was a factor associated with neonatal hypoglycemia (OR＝7.04, 95%CI 1.75–28.23, P＝0.006).

Conclusions Puerpera women receiving preoperative oral CHO experienced less postoperative thirst and hunger and had higher overall satisfaction than those who did not receive CHO, but the risk of neonatal hypoglycemia increased.