The Changing Presentations of Diabetic Ketoacidosis During Pregnancy

Mark T. Cullen; E. Albert Reece; Carol J. Homko; Eyal Sivan

doi:10.1055/s-2007-994386

American Journal of Perinatology, Table of Contents

Am J Perinatol 1996; 13(7): 449-451
DOI: 10.1055/s-2007-994386

ORIGINAL ARTICLE

The Changing Presentations of Diabetic Ketoacidosis During Pregnancy

Mark T. Cullen¹ , E. Albert Reece¹ ^, ² , Carol J. Homko² , Eyal Sivan²

¹Yale Diabetes-in-Pregnancy Study Unit, Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at Yale University School of Medicine, New Haven, Connecticut
²Diabetes-in-Pregnancy Program in the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences at Temple University School of Medicine, Philadelphia, Pennsylvania

Abstract

ABSTRACT

The purpose of the present study was to examine the presentation and outcomes associated with diabetic ketoacidosis (DKA) in pregnancies complicated by diabetes. Eleven episodes (2%) of DKA were diagnosed during the 10-year study period. All patients were under close observation by the Diabetes-in-Pregnancy Service. Plasma glucose levels of less than 200 mg/dL were present in 4 of the 11 patients (36%), 10 (90%) of whom presented with nausea, vomiting, and decreased caloric intake. Two subsequently had fetal distress necessitating cesarean section. One fetal death occurred in a patient treated with subcutaneous insulin. Despite contemporary methods of diabetes care, near-normal plasma glucose levels are not enough to preclude diabetic ketoacidosis. Nausea, vomiting, and decreased caloric intake in an otherwise normal pregnant, diabetic woman requires evaluation to exclude ketosis.

Keywords

Pregnancy - diabetic ketoacidosis - fetal distress

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