title: Ketonemia and ketonuria in gestational diabetes mellitus.
abstract: BACKGROUND
  The use of capillary blood 3-β-hydroxybutyrate (3HB) is a more precise method than urine ketones measurement for the diagnosis of diabetic ketoacidosis. Fasting ketonuria is common during normal pregnancy, while there is evidence that it is increased among pregnant women with Gestational Diabetes Mellitus (GDM) who are on a diet. 3HB levels have been related to impaired offspring psychomotor development. Reports with concomitant measurement of blood and urine ketones in women with GDM who followed a balanced diet are lacking.
  
  
  OBJECTIVE
  To compare the prevalence of fasting ketonemia and ketonuria in women with GDM following the Institute of Medicine diet instructions and assess their possible relation with metabolic parameters and therapeutic interventions.
  
  
  METHODS
  180 women with GDM were studied. In each patient, in successive visits, capillary blood and urine ketones were simultaneously measured. The total measurements were 378, while the average number of measurements per patient was 2.1.
  
  
  RESULTS
  The prevalence of ketonuria was significantly higher than that of ketonemia (x(2)=21.33, p &#60;0.001). Significantly higher mean 3HB levels were observed with respect to ketonuria severity (p=0.001). Bedtime carbohydrate intake was associated with significantly lower 3HB levels (p=0.035). Insulin treatment was associated with significant 3HB levels reduction (p=0.032). Body weight reduction per week between two serial visits was associated with increased 3HB levels (p=0.005). Multiple linear regression analysis showed that weight loss remained the only independent predictor of 3HB levels.
  
  
  CONCLUSIONS
  The presence of ketonemia was significantly lower than the presence of ketonuria. Weight loss per week was the only independent factor found to be associated with increased levels of 3HB. The clinical significance of this small increase requires further investigation.
authors.affiliation: Diabetes Center, 1st Endocrine Section, Alexandra General Hospital, Athens, Greece.
authors.forename: Loukia
authors.initials: L
authors.lastname: Spanou
authors.affiliation: Faculty of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Dalakleidi
authors.affiliation: Faculty of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece.
authors.forename: Konstantia
authors.initials: K
authors.lastname: Zarkogianni
authors.affiliation: Diabetes Center, 1st Endocrine Section, Alexandra General Hospital, Athens, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Papadimitriou
authors.affiliation: Diabetes Center, 1st Endocrine Section, Alexandra General Hospital, Athens, Greece.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Nikita
authors.affiliation: Diabetes Center, 1st Endocrine Section, Alexandra General Hospital, Athens, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Vasileiou
authors.affiliation: Diabetes Center, 1st Endocrine Section, Alexandra General Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Alevizaki
authors.affiliation: Diabetes Center, 1st Endocrine Section, Alexandra General Hospital, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Anastasiou
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood; D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016009:Chi-Square Distribution; D016640:Diabetes, Gestational / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000652:urine; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000652:urine; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007659:Ketones / Q000652:urine; D016014:Linear Models; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D007004:Hypoglycemic Agents; D007328:Insulin; D007659:Ketones; D020155:3-Hydroxybutyric Acid