Ketoacidosis in Gestational Diabetes

Ketoacidosis in Gestational Diabetes

Diabetic ketoacidosis (DKA) is a rare complication of diabetes.1 It is a medical emergency characterized by hyperglycemia (high blood glucose levels), metabolic acidosis and ketosis (the buildup of acid and ketones, respectively, in the blood), and dehydration. 


How Can DKA Occur During Pregnancy?

Physiological changes during pregnancy (eg, relative insulin resistance, hormonal changes) can predispose women to DKA.2 Pregnant women with pregestational T1DM are also at a greater risk of developing DKA at lower blood glucose levels.3 Factors such as infections, starvation, insulin non-compliance, and hyperemesis gravidarum (a severe form of nausea and vomiting) may precipitate DKA in pregnancy.3,4

What Are the Symptoms of DKA?

Symptoms of DKA in pregnancy are similar to symptoms in non-pregnant individuals.5 The signs and symptoms vary based on the severity of DKA, but excessive thirst and urination are common.6,7 If not urgently treated, DKA can lead to coma and even death.  

Early Symptoms of DKA:

  • Excessive thirst
  • Excessive urination
  • Weight loss
  • Fatigue and weakness
  • Nausea and vomiting
  • Abdominal pain
  • Dehydration 

Late Symptoms of DKA:

  • Labored breathing
  • Fruity-smelling breath
  • Extreme lethargy
  • Coma


Why Is DKA Dangerous During Pregnancy?

DKA is particularly dangerous during pregnancy as it is associated with high rates of stillbirth, preterm birth, and neonatal intensive care unit admissions.3,4,8 The mother’s overall health status, health behaviors, and the severity of the DKA event are important factors that affect the health of the baby in the event of a DKA.8

How Do You Prevent DKA During Pregnancy?

Adhering to medication plans and regularly monitoring blood glucose levels are important in DKA prevention.6 Blood glucose levels should be monitored more frequently during illnesses, and urine ketone levels should be checked every four to six hours if glucose levels measure >240 mg/dL.9 Ketone strips should be prescribed to pregnant women with type 1 diabetes.3 A blood ketone meter can be very effective in allowing earlier detection of DKA.Education on DKA prevention and detection should also be given.


1. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic Ketoacidosis. Nat Rev Dis Primers. 2020;6(1):1-20. doi:10.1038/s41572-020-0165-1
2. Mohan M, Baagar KAM, Lindow S. Management of Diabetic Ketoacidosis in Pregnancy. Obstet Gynecol. 2017;19(1):55-62. doi:10.1111/tog.12344
3. American Diabetes Association Professional Practice Committee. 15. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2021;45(Supplement_1):S232-S243. doi:10.2337/dc22-S015
4. Tanner HL, Dekker Nitert M, Callaway LK, Barrett HL. Ketones in Pregnancy: Why Is It Considered Necessary to Avoid Them and What Is the Evidence Behind Their Perceived Risk? Diabetes Care. 2020;44(1):280-289. doi:10.2337/dc20-2008
5. Kamalakannan D, Baskar V, Barton DM, Abdu T a. M. Diabetic Ketoacidosis in Pregnancy. Postgrad Med J. 2003;79(934):454-457. doi:10.1136/pmj.79.934.454
6. Westerberg DP. Diabetic Ketoacidosis: Evaluation and Treatment. Am Fam Physician. 2013;87(5):337-346.
7. Gosmanov AR, Kitabchi AE. Diabetic Ketoacidosis. In: Feingold KR, Anawalt B, Blackman MR, et al., eds. Endotext., Inc.; 2000. Accessed February 14, 2023.
8. Morrison FJR, Movassaghian M, Seely EW, et al. Fetal Outcomes After Diabetic Ketoacidosis During Pregnancy. Diabetes Care. 2017;40(7):e77-e79. doi:10.2337/dc17-0186
9. CDC. Diabetic Ketoacidosis. Centers for Disease Control and Prevention. Published March 25, 2021. Accessed February 14, 2023.



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