title: Diabetic ketoacidosis complicating pregnancy.
abstract: BACKGROUND
  Although diabetic ketoacidosis (DKA) in pregnancy can result in significant adverse consequences for both mother and fetus, the response to treatment, time course of recovery, and perinatal outcomes have not been well studied in pregnancy.
  
  
  OBJECTIVE
  We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA.
  
  
  METHODS
  This is a retrospective cohort study of pregnancies complicated by DKA between October 1999 and June 2015. The diagnosis was verified by hyperglycemia; anion gap >12 mEq/L, pH <7.3, HCO3 <15 mEq/L; and the presence of ketones. Each episode of DKA was reviewed and subsequent perinatal outcomes analyzed.
  
  
  RESULTS
  During this period, we identified 33 women with 40 admissions (incidence: 0.2%). The majority of women had type 1 diabetes (67%), and almost all presented with nausea and vomiting (97%). Over half had poor compliance with prescribed insulin. The initial mean blood glucose was 380 mg/dL, within 6 hours, it was <200 mg/dL. By 12 hours, the acidosis had resolved in 90% of patients.
  
  
  CONCLUSIONS
  Nausea and vomiting is a prominent presenting feature of DKA in pregnancy. With aggressive insulin and resuscitation, hyperglycemia and acidosis improve rapidly. With current treatment, good perinatal outcomes can be expected.
authors.forename: S N
authors.initials: SN
authors.lastname: Bryant
authors.forename: C L
authors.initials: CL
authors.lastname: Herrera
authors.forename: D B
authors.initials: DB
authors.lastname: Nelson
authors.forename: F G
authors.initials: FG
authors.lastname: Cunningham
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section; D000013:Congenital Abnormalities / Q000453:epidemiology; D000077324:Crystalloid Solutions; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005313:Fetal Death; D005440:Fluid Therapy / Q000379:methods*; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000453:epidemiology; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007328:Insulin / Q000627:therapeutic use*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007552:Isotonic Solutions / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000077324:Crystalloid Solutions; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D007552:Isotonic Solutions; C517652:hemoglobin A1c protein, human
keywords: Diabetes; diabetic ketoacidosis; pregnancy