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

Abstract

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.