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Diabetic Ketoacidosis in Pregnancy: Clinical Risk Factors, Presentation, and Outcomes
Maheswaran Dhanasekaran1, Sneha Mohan1,2, Dana Erickson1
1Department of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA.
The Journal of Clinical Endocrinology and Metabolism
|August 2, 2022
Summary
Diabetic ketoacidosis (DKA) during pregnancy poses significant risks, leading to fetal demise in 17.2% of cases. Enhanced prenatal education and clinical vigilance are crucial for preventing this obstetric emergency.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Neonatal Medicine
Background:
- Diabetic ketoacidosis (DKA) in pregnancy is a critical obstetric emergency with a high risk of maternal and fetal mortality.
- Effective management and prevention strategies are essential for improving pregnancy outcomes in affected women.
Purpose of the Study:
- To evaluate diabetic ketoacidosis (DKA) events in pregnant women.
- To identify clinical risk factors, presentation patterns, and pregnancy outcomes associated with DKA during gestation.
Main Methods:
- A retrospective cohort study was conducted at the Mayo Clinic, USA, from 2004 to 2021.
- Included women aged 17-45 years treated for DKA during pregnancy.
- Maternal and fetal death, alongside a spectrum of pregnancy outcomes, were the primary outcome measures.
Main Results:
- 71 DKA events occurred in 58 pregnancies; 10 (17.2%) resulted in fetal demise (6 miscarriages, 4 stillbirths).
- Maternal social stressors (51.0%) and suboptimal glycemic control (median HbA1c 9.0%) were common.
- Infants experienced high rates of being large for gestational age (33.3%), neonatal hypoglycemia (60.4%), and NICU admission (52.1%).
Conclusions:
- DKA in pregnancy is linked to substantial maternofetal morbidity and fetal loss.
- Prenatal education emphasizing DKA prevention is vital for women with diabetes mellitus.
- Clinicians and patients require heightened awareness for DKA symptoms in pregnant women.
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