Preoperative Carbohydrate Loading in Enhanced Recovery After Cesarean Protocols: Metabolic and Early Neonatal Outcomes

Background: Enhanced Recovery After Cesarean (ERAC) protocols increasingly incorporate preoperative carbohydrate (CHO) loading to mitigate surgical stress and improve maternal recovery. However, concerns persist regarding its potential impact on neonatal metabolic and acid–base status. Methods: A narrative review of randomized controlled trials, observational studies, and meta-analyses published between 2019 and 2025 was conducted, focusing on neonatal outcomes following maternal preoperative CHO loading before elective cesarean delivery. Primary outcomes included Apgar scores and umbilical cord arterial pH, while secondary outcomes addressed neonatal glucose homeostasis and metabolic biomarkers. Results: Across available studies, preoperative CHO loading was not associated with adverse Apgar scores or clinically relevant neonatal acidosis. Minor statistically significant differences in umbilical cord pH reported in some cohorts remained within physiological ranges. Conversely, CHO loading consistently reduced the incidence of neonatal hypoglycemia, albeit with an increased rate of transient, clinically benign hyperglycemia. Emerging evidence also suggests reduced neonatal metabolic stress at a cellular level, reflected by lower purine degradation products in umbilical cord blood. Conclusions: Preoperative CHO loading within ERAC protocols appears metabolically safe for the neonate and confers clinically meaningful protection against neonatal hypoglycemia. While its superiority over liberal clear-fluid strategies for maternal comfort remains debated, its metabolic benefits support its role as a targeted nutritional intervention in elective cesarean delivery.