Diabetic ketoacidosis complicating pregnancy

Abstract

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.

Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection

“…Increased lipolysis and free fatty acid delivery to the liver causes increased ketogenesis. Also, the respiratory alkalosis in late pregnancy causes increased urinary excretion of bicarbonate and metabolic acidosis [15]. Thus, pregnancy leads to euglycemia, ketosis, and acidosis.…”

Features of insulin therapy in patients with type 1 diabetes mellitus during pregnancy

“…Во время беременности у женщин с СД-1 существенно повышается риск возникновения тяжелой гипогликемии и кетоацидоза, что резко повышает риск смерти матери и плода. [2,3]. Контррегуляторные механизмы, корректирующие гипогликемию и обеспечивающие развитие ее симптомов, существенно снижены при беременности на фоне СД-1.…”

“…Высокий уровень информированности женщин с СД-1 о рисках недостаточного контроля диабета, улучшение контроля глюкозы крови, совершенствование методов доставки инсулина, оптимизация и индивидуальный подбор режима и доз введения инсулина, применение новых безопасных высококачественных аналогов инсулина привело к УДК 618. 3 Особенности инсулинотерапии у пациенток с сахарным диабетом 1 типа во время беременности снижению детской и материнской смертности с 20% в 1950 годах до менее 3% в 1980-х годах [2].…”

Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population‐based retrospective cohort study

“…Pregnancies complicated with pregestational diabetes are associated with more complications than pregnancies with gestational diabetes mellitus (GDM). These include increased risk for fetal malformations, spontaneous miscarriages, development and worsening of maternal diabetic retinopathy and nephropathy, diabetic ketoacidosis, risk of venous thromboembolism, antepartum hemorrhage, placental disorders, shoulder dystocia, neonatal hyperbilirubinemia and hypoglycemia, and increased medical cost …”

“…These include increased risk for fetal malformations, spontaneous miscarriages, development and worsening of maternal diabetic retinopathy and nephropathy, diabetic ketoacidosis, risk of venous thromboembolism, antepartum hemorrhage, placental disorders, shoulder dystocia, neonatal hyperbilirubinemia and hypoglycemia, and increased medical cost. [4][5][6][7][8][9][10][11] Pregestational diabetes should be distinguished from GDM since the pregnancy follow-up of those women is different with respect to pregnancy outcomes, management, type of glycemic control treatment, and timing of delivery. In pregestational diabetes, the mother should be evaluated for retinopathy, nephropathy, chronic hypertension, thyroid dysfunction, and infections.…”