Intrapartum Results on Differing Degrees of Ketonuria in Nulliparous Women with Gestational Diabetes Mellitus during Spontaneous Labor

Abstract

To compare intrapartum results associated with differing degrees of ketonuria in nulliparous women with gestational diabetes mellitus (GDM), we implemented a retrospective cohort study comparing clinical characteristics among differing degrees of ketonuria and the duration and distribution of ketonuria at different stages of labor. We also analyzed adverse maternal and neonatal outcomes for each group. A total of 570 GDM deliveries were included; of these, 238 had negative ketonuria (41.8%), 180 had moderate ketonuria (31.6%), and 152 had ketosis (26.6%). The proportion of patients with a family history of diabetes significantly increased as the degree of ketonuria increased (P < 0.001). Moreover, a significantly lower level of HOMA-IR (the insulin resistance index) was observed for the Negative group (P < 0.001). The triglyceride (TG) level was significantly higher in the Ketosis group (P < 0.001), and the total cholesterol (TC) levels significantly increased as the degree of ketonuria progressed (P < 0.001). There were also higher maternal blood sugar levels and a significantly higher proportion of oxytocin augmentation in ketonuria cases (P < 0.001). Over three-fourths of patients (75.6%) had a ketonuria duration of ≤2 hours in the Moderate group, 61.2% had a ketonuria duration of between 3 and 4 h in the Ketosis group, and most of the ketonuria cases resolved in the first stage of labor. As the degree of ketonuria progressed, we observed a significantly higher number of cases with fetal heart rate pattern III (FHR pattern III), meconium-stained amniotic fluid III (MSAF III), postpartum hemorrhages, prolonged labor, neonatal hypoglycemia, an umbilical cord arterial pH of <7.2, low Apgar scores, increased neonatal intensive care admissions, augmented forceps-assisted deliveries, and conversions to cesarean sections. The results showed that ketonuria is common during the intrapartum period and that the risk of adverse maternal and neonatal outcomes may increase when complicated with ketonuria.

The Gestational Diabetes Mellitus Approach in Clinical Practice – A Narrative Review

“…Follow-up of the patient with GDM Throughout the pregnancy, the patient is monitored by a multidisciplinary medical team. Monitoring includes glycemic control, HbA1C, weight gain, assessment of kidney function by creatinine clearance and albuminuria, ketonuria, blood pressure measurement and ophthalmological control [65].…”

<p>Effect of Elevated Ketone Body on Maternal and Infant Outcome of Pregnant Women with Abnormal Glucose Metabolism During Pregnancy</p>

“…In 2018, Huang et al monitored and recorded the urinary ketones and delivery results of 570 pregnant women with GDM during childbirth and found that maternal ketonuria is quite common in women with GDM who have not given birth. 26 According to the different urine ketone content, 570 subjects were divided into three groups: negative, moderate ketonuria and ketosis. By comparing the birth complications between different urine ketone levels, Huang SY et al found that incidences of FHR III, third-degree amniotic fluid contamination, and postpartum hemorrhage increased with the development of ketonuria.…”