Diabetic ketoacidosis in pregnancy is associated with increased perinatal mortality and warrants more attention in clinical guidelines, a new study suggests

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A new study investigating the epidemiology, clinical profile, outcomes, and risk factors of diabetic ketoacidosis (DKA) in pregnancy suggests that despite having a low incidence, it is associated with increased perinatal mortality and thus warrants more attention. The findings were published in the journal Diabetic Medicine.

The prevalence of diabetes in the reproductive population is on the rise, yet our understanding of DKA in pregnancy remains poor. Furthermore, national guidelines fail to specifically address the management of DKA in pregnancy.

Researchers conducted a population-based case-control study using data collected by the UK Obstetric Surveillance System between April 2019 and September 2020. The study included pregnant women with diabetes managed for DKA, regardless of their blood glucose levels (cases), and pregnant women with diabetes who did not have DKA (controls).

The overall incidence of DKA in pregnancy was 6.3 per 100,000 maternities. One in 60 (1.6%) pregnant women with type 1 diabetes and one in 900 (0.11%) with type 2 diabetes experienced DKA. The majority of DKA episodes occurred in women with type 1 diabetes (85%) and during the third trimester of pregnancy (71%). The most common triggers for DKA were infection, vomiting, steroid therapy, and medication error.

In half of the DKA episodes, blood glucose levels were either normal or mildly elevated and 15% of the women experienced more than one DKA episode during the course of their pregnancy. No maternal deaths were reported, but women with DKA carried a higher risk of stillbirth (OR, 12.88) and preterm birth (OR, 9.14) compared with controls. 

In a multivariable analysis, independent risk factors for DKA in women with type 1 diabetes included the woman and/or her partner being unemployed (adjusted OR, 3.64) and the presence of any diabetes complication (adjusted OR, 2.69).

The authors said: ‘Guidelines are needed on pre-pregnancy care as well as the optimum management of DKA in pregnancy (including location of care) and on appropriate obstetric/diabetes management following episodes of DKA, given the high risk of recurrent DKA, preterm birth, and stillbirth.’

This article originally appeared on Univadis, part of the Medscape Professional Network.


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