Ketoacidosis in Diabetic Pregnancy

Kilvert, J.A.; Nicholson, H. Oliphant; Wright, Alex

doi:10.1111/j.1464-5491.1993.tb00059.x

Cited by 43 publications

(23 citation statements)

References 13 publications

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“…[5][6][7][8][9][10][11] Historically, the reported incidence of diabetes in pregnancy ranges from 6% to 7% with 90% of these cases representing women with GDM. 12, 13 The two populations with the highest risk of diabetes in pregnancy are obese African Americans and those of Hispanic or Latino descent with an overall prevalence as high as 30%.…”

Section: Incidencementioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

107

112

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Pregnancies complicated by diabetic ketoacidosis are associated with increased rates of perinatal morbidity and mortality. A high index of suspicion is required, because diabetic ketoacidosis onset in pregnancy can be insidious, usually at lower glucose levels, and often progresses more rapidly as compared with nonpregnancy. Morbidity and mortality can be reduced with early detection of precipitating factors (ie, infection, intractable vomiting, inadequate insulin management or inappropriate insulin cessation, β-sympathomimetic use, steroid administration for fetal lung maturation), prompt hospitalization, and targeted therapy with intensive monitoring. A multidisciplinary approach including a maternal-fetal medicine physician, medical endocrinology specialists familiar with the physiologic changes in pregnancy, an obstetric anesthesiologist, and skilled nursing is paramount. Management principles include aggressive volume replacement, initiation of intravenous insulin therapy, correction of acidosis, correction of electrolyte abnormalities and management of precipitating factors, as well as monitoring of maternal-fetal response to treatment. When diabetic ketoacidosis occurs after 24 weeks of gestation, fetal status should be continuously monitored given associated fetal hypoxemia and acidosis. The decision for delivery can be challenging and must be based on gestational age as well as maternal-fetal responses to therapy. The natural inclination is to proceed with emergent delivery for nonreassuring fetal status that is frequently present during the acute episode, but it is imperative to correct the maternal metabolic abnormalities first, because both maternal and fetal conditions will likewise improve. Prevention strategies should include education of diabetic pregnant women about the risks of diabetic ketoacidosis, precipitating factors, and the importance of reporting signs and symptoms in a timely fashion.

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Section: Incidencementioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

107

112

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“…4 The incidence rates of diabetic ketoacidosis in pregnancy and the corresponding fetal mortality rates from different retrospective studies [5][6][7][8] are summarised in the table 1. As is evident from the table, both the incidence and rates of fetal loss in pregnancies have fallen in recent times compared with those before.…”

Section: Magnitude Of the Problemmentioning

confidence: 99%

Diabetic ketoacidosis in pregnancy

Kamalakannan

Baskar²,

Barton³

et al. 2003

Postgraduate Medical Journal

127

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The occurrence of diabetic ketoacidosis in pregnancy compromises both the fetus and the mother. It usually occurs in the later stages of pregnancy and is also seen in newly presenting type 1 diabetes patients. Despite improvement in its incidence rates and outcomes over the years, it still remains a major clinical problem since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis. This article illustrates a typical case of diabetic ketoacidosis in pregnancy and reviews the literature to provide an insight into its pathophysiology and management.

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“…Again, fortunately for us, the incidence of DKA in pregnancy has declined substantively over the years, and so has the perinatal mortality (Table 1) (1)(2)(3)(4)(5). However, the importance of providing prompt, effective medical care is unaltered or perhaps even increased, due to the unrealistic expectation for a perfect outcome for all pregnancies.…”

mentioning

confidence: 99%