The impact of maternal ketonuria on fetal test results in the setting of postterm pregnancy.
OBJECTIVE
The aim of this study was to determine whether ketonuria, a commonly assessed urinary marker of maternal starvation and dehydration, is associated with abnormal fetal test results in the setting of postterm pregnancy.


METHODS
During a 4-year period (January 1993-December 1996), a total of 3655 visits for antepartum maternal-fetal testing of postterm pregnancies (> or =41 weeks' gestation) occurred at our institution. Maternal assessment included vital signs and urinalysis. The presence and degree of maternal ketonuria was correlated against abnormal results of fetal heart rate tests, nonstress tests, amniotic fluid index measurements, and biophysical profile scores performed on the same day.


RESULTS
There were 3601 encounters suitable for inclusion in the study. Clinically detectable ketonuria occurred in 10.9% of the patients studied. Patients with clinically detectable ketonuria were at increased risk relative to patients without ketonuria for abnormal outcomes during postterm testing, including the presence of oligohydramnios (24% vs. 9.3%; P<.0001 ), nonreactive nonstress tests (6.2% vs. 2.15%; P<.0001), and fetal heart rate decelerations (14% vs 9.2%; P =.0039 ).


CONCLUSIONS
Maternal ketonuria among patients with postterm pregnancy was associated with a >2-fold increase in the occurrence of oligohydramnios, a 3-fold increase in nonreactive nonstress tests, and a significant increase in fetal heart rate decelerations. Further studies are required to evaluate the potential benefits of treating ketonuria before fetal testing.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Lenox Hill Hospital, Albert Einstein College of Medicine, NY 10021, USA.
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D000328:Adult; D000653:Amniotic Fluid; D000704:Analysis of Variance; D001835:Body Weight; D003681:Dehydration / Q000150:complications; D005260:Female; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D007657:Ketone Bodies / Q000652:urine*; D016014:Linear Models; D016104:Oligohydramnios / Q000209:etiology*; D010298:Parity; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000652:urine*; D013046:Specific Gravity; D016482:Urinalysis
D007657:Ketone Bodies