Management of diabetic ketoacidosis in pregnancy

Mohan, Manoj; Baagar, Khaled; Lindow, Stephen W.

doi:10.1111/tog.12344

Cited by 28 publications

(27 citation statements)

References 25 publications

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“…Conditions and risk factors that can contribute to the development of DKA include hyperemesis, gastroenteritis, infection, non-compliance with insulin regime, use of steroids and insulin pump failure. During pregnancy, a woman is in a state of relative insulin resistance, respiratory alkalosis and has changes in the levels of progesterone, cortisol and human placental lactogen 4. These characteristics unique to pregnancy predispose them to DKA.…”

Section: Discussionmentioning

confidence: 99%

Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis

Devendra

et al. 2018

BMJ Case Reports

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Diabetic ketoacidosis (DKA) during pregnancy is a serious metabolic complication of diabetes with high mortality and morbidity if not detected and treated immediately. We report a case of a woman with type 1 diabetes mellitus who had poorly controlled diabetes in the first half of pregnancy and developed DKA at 29 weeks gestation. At presentation, she had a pathological fetal heart tracing but delivery was delayed for maternal stabilisation and reversal of acidosis. Once hyperglycaemia, acidosis and maternal stabilisation were achieved, fetal compromise resolved and delivery was no longer indicated. The patient was subsequently discharged home. She delivered vaginally a 2400 g baby at 34 weeks gestation after presenting with spontaneous rupture of membranes.

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Section: Discussionmentioning

confidence: 99%

Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis

Devendra

et al. 2018

BMJ Case Reports

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“…Euglycemic DKP is related with multiple physiological processes that occur during pregnancy [6]: the striking glucose usage by the fetoplacental unit, glycosuria due to an increased glomerular filtration rate, enhanced glucose utilization by estrogen and progesterone effects, and expanded plasma volume, which dilutes the circulating glucose. Additionally, the accelerated starvation state associated with pregnancy leads to lipolysis and ketosis accompanied with depleted glycogen stores and impaired glucose production that predisposes the person to euglycemic DKP [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Although some experts recommend bicarbonate therapy with a pH<6.9 [29], others do not [30], as there is no evidence of its benefit and it may be associated with harm to the mother and fetus. Bicarbonate hinders the recovery of ketosis, may deteriorate hypokalemia [24], and may increase carbon dioxide (CO 2 ) partial pressure (PCO 2 ) because it decreases the compensatory hyperventilation that helps to eliminate CO 2 . High PCO 2 impairs fetal oxygen delivery [31] and may lead to paradoxical cerebral acidosis because CO 2 passes through the blood brain barrier faster than bicarbonate [24].…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Diabetic Ketoacidosis in Pregnant Women over a Period of 3 Years

Baagar¹,

Aboudi²,

Khaldi³

et al. 2017

Endocrinol Metab Syndr

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Objective: The incidence of diabetic ketoacidosis in pregnancy (DKP) varies from 0.5%, the lowest reported rate in western countries, to 8.9% in a study conducted in China. The associated fetal mortality is 9-36%. This study aimed to assess the current incidence, causes, and outcomes of diabetic ketoacidosis in pregnancy and identify factors associated with favorable outcomes. Methods:A retrospective chart review of 20 diabetic ketoacidosis hospital admissions of 19 pregnant women from 3,679 diabetic pregnancies delivered between June 2012 and May 2015 was conducted. Those with successful DKP management (group A) or with intrauterine fetal death or urgent delivery during diabetic ketoacidosis management (group B) were compared.Results: Thirteen cases had type 1 diabetes, and 6 cases had type 2 diabetes, including 2 new diagnoses. The most common precipitating factors were vomiting (55%) and insulin non-compliance (45%). Plasma glucose was <200 mg/dl in 50% of the patients. There was no maternal mortality, but there was one fetal death (5%). Only mean gestational age (21.8 ± 11.0 versus 33.7 ± 4.6 weeks, P=0.005) was significantly different between groups A (14 admissions) and B (6 admissions). Conclusion:The incidence of diabetic ketoacidosis was 0.5%, similar to the lowest incidence previously reported. Fetal mortality was 5%, lower than previously reported. The only factor associated with a favorable outcome was early gestational age at presentation. We recommend antenatal screening for diabetes, patient education, and compliance with insulin treatment as preventive measures against DKP.

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“…There is no consensus on further fetal monitoring after resolution of DKP especially in preterm fetuses. 2,11,12 Prevention of diabetic ketoacidosis in pregnancy Preconception counseling, diabetes screening and education of the woman in obstetric and diabetic clinic are important in preventing DKP in diabetic pregnancies. 9 Women diagnosed with diabetes should be educated about how to identify the precip- have a glucose meter for self-monitoring and those with type 1 diabetes should have a ketone meter.…”

Section: Fetal Monitoring In Diabetic Ketoacidosis In Pregnancymentioning

confidence: 99%

“…The reported incidence of DKP in all diabetic pregnancies ranges from 0.5-3% depending on the population studied. 1,2,10,12…”

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confidence: 99%

Diabetic ketoacidosis in pregnancy

Kalantzis¹,

Pappa²

2019

HJOG

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Diabetic ketoacidosis in pregnancy is a rare but potential life-threatening condition for the mother and the fetus. Although predictably DKP is more common in patients with type 1 diabetes, it has been reported too in those with type 2 diabetes as well as gestational diabetes. Diabetic ketoacidosis usually occurs in the second and third trimesters because of insulin resistance. Prompt recognition and aggressive treatment of this condition are essential in order to reduce perinatal mortality and morbidity. Despite improvement in its incidence rates and outcomes over the years, it still remains a major clinical problem that posesseveral challenges with respect to diagnosis and management.

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Management of diabetic ketoacidosis in pregnancy

Cited by 28 publications

References 25 publications

Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis

Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis

Retrospective Analysis of Diabetic Ketoacidosis in Pregnant Women over a Period of 3 Years

Diabetic ketoacidosis in pregnancy

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