Diabetic ketoacidosis complicating pregnancy

• Published in: Journal of neonatal-perinatal medicine Vol. 10; no. 1; pp. 17 - 23
• Main Authors: Bryant, S N, Herrera, C L, Nelson, D B, Cunningham, F G
• Format: Journal Article
• Language: English
• Published: Netherlands 2017
• Subjects: Abortion, Spontaneous - epidemiology; Adult; Birth Weight; Cesarean Section; Congenital Abnormalities - epidemiology; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - metabolism; Diabetes Mellitus, Type 1 - therapy; Diabetic Ketoacidosis - epidemiology; Diabetic Ketoacidosis - metabolism; Diabetic Ketoacidosis - therapy; Disease Progression; Female; Fetal Death; Fluid Therapy - methods; Gestational Age; Glycated Hemoglobin A - metabolism; Humans; Hyperbilirubinemia, Neonatal - epidemiology; Hypoglycemia - epidemiology; Hypoglycemic Agents - therapeutic use; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Insulin - therapeutic use; Intensive Care Units, Neonatal - utilization; Isotonic Solutions - therapeutic use; Pre-Eclampsia - epidemiology; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications - metabolism; Pregnancy Complications - therapy; Pregnancy in Diabetics - epidemiology; Pregnancy in Diabetics - metabolism; Pregnancy in Diabetics - therapy; Premature Birth - epidemiology; Retrospective Studies; Texas - epidemiology; Young Adult; diabetic ketoacidosis; pregnancy; Diabetes
• ISSN: 1934-5798; 1878-4429
• DOI: 10.3233/NPM-1663

Although diabetic ketoacidosis (DKA) in pregnancy can result in significant adverse consequences for both mother and fetus, the response to treatment, time course of recovery, and perinatal outcomes have not been well studied in pregnancy. We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA. This is a retrospective cohort study of pregnancies complicated by DKA between October 1999 and June 2015. The diagnosis was verified by hyperglycemia; anion gap >12 mEq/L, pH <7.3, HCO3 <15 mEq/L; and the presence of ketones. Each episode of DKA was reviewed and subsequent perinatal outcomes analyzed. During this period, we identified 33 women with 40 admissions (incidence: 0.2%). The majority of women had type 1 diabetes (67%), and almost all presented with nausea and vomiting (97%). Over half had poor compliance with prescribed insulin. The initial mean blood glucose was 380 mg/dL, within 6 hours, it was <200 mg/dL. By 12 hours, the acidosis had resolved in 90% of patients. Nausea and vomiting is a prominent presenting feature of DKA in pregnancy. With aggressive insulin and resuscitation, hyperglycemia and acidosis improve rapidly. With current treatment, good perinatal outcomes can be expected.