Furthermore, timely recognition and management of DKA in pregnancy are crucial for optimizing outcomes. Future work should focus on optimizing prevention strategies in high-risk women. Dhanasekaran M, et al. Diabetic ketoacidosis in pregnancy: Clinical risk factors, presentation, and outcomes.

Refer a patient to Mayo Clinic. This content does not have an English version. This content does not have an Arabic version. Diabetic ketoacidosis in pregnancy poses mortality risk.

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Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers. Sign up for free e-newsletters. T1D is, however, considered to be an autoimmune disease caused by autoantibodies against pancreatic β-cells The presence of anti-GAD antibodies has also been shown to be predictive of the onset of postpartum diabetes in women with GDM Despite reports that genotypes differ according to ethnicity, Padoa found no ethnic difference between black Africans and white persons with T1D in South Africa Anti-GAD antibodies were tested in twenty-one women without known T1D at the time of DKA in our study.

These included 14 with HFDP and seven women with a prior diagnosis of T2D. In light of these findings, we believe that pregnant women with DKA should be strongly considered for auto-immune diabetes regardless of their BMI or prior classification as T2D.

Knowledge of anti-GAD antibody status in this subset of pregnant mothers may be particularly useful to determine insulin dependency or in identifying women who might benefit from emerging treatments for the prevention of T1D.

In our background reproductive female population, we have a heavy metabolic footprint and obesity is a specific concern. There is some controversy as to whether obesity trends in the general population are indicative of obesity rates in people with T1D, or whether they are related by genetics and environmental susceptibilities 68 , Nearly half of women with T1D who had a DKA event in pregnancy in our study were overweight or obese, thus warning against reliance on clinical phenotype to dictate diabetes subtyping.

The findings of this study are consistent with recent findings from other studies that indicate that obesity is a highly prevalent problem in individuals with T1D 68 — According to Evertsen et al.

Most women in our cohort had some form of hypertension. Surprisingly neither hypertension nor pre-eclampsia were present in any of their pregnancies with fetal loss DKAs in pregnancy have rarely been studied in detail at the patient level.

Due to the retrospective and descriptive nature of this study, causality cannot be inferred, however, it contributes to the current knowledge of pregnancy outcomes and complications associated with DKA.

The small sample size prohibited robust statistical analysis. Furthermore, neither the specific socioeconomic status of the participants nor their competency in managing their diabetes were formally assessed.

The high rates of obesity and hypertensive disorders, as well as suboptimal antenatal glycemic control, potentially contributed to the high number of intrauterine deaths observed. Significant implementation gaps remain in screening for hyperglycemia and antenatal diabetes care in resource-constrained environments.

These gaps must be eliminated if dangerous complications like DKA are to be minimized Clinicians should strive to ensure continuous development and implementation of strategies that ensure optimal preconception and antenatal management of diabetes, as well as empowering women with diabetes through education.

Unintended iatrogenic consequences of DKA management such as hypokalemia and hypoglycemia should be minimized with strict protocols to limit the possibility of fetal loss. In the context of high-risk populations for DKA and healthcare providers, we emphasize the importance of ongoing structured diabetes education.

Through the use of these data, local practices can develop targeted protocols and interventions that can decrease the risks associated with hypokalemia, ultimately improving patient outcomes and inspiring a culture of continuous improvement. This study found a high risk of fetal mortality and undiagnosed auto-immune diabetes in women with DKA during pregnancy.

There was a strong correlation between hypokalemia and fetal loss, suggesting a window of opportunity for addressing management gaps. The datasets presented in this study can be found in online repositories. The study complied with the World Medical Association Declaration of Helsinki.

The studies were conducted in accordance with the local legislation and institutional requirements. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al.

IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for and Diabetes Res. doi: PubMed Abstract CrossRef Full Text Google Scholar. Burden of diabetes and first evidence for the utility of HbA1c for diagnosis and detection of diabetes in urban black South Africans: the durban diabetes study.

Staiger H editor PloS One 11 8 :e CrossRef Full Text Google Scholar. Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, et al. American Diabetes Association Professional Practice Committee. Classification and diagnosis of diabetes: standards of medical care in diabetes— Chivese T, Hoegfeldt CA, Werfalli M, Yuen L, Sun H, Karuranga S, et al.

IDF Diabetes Atlas: The prevalence of pre-existing diabetes in pregnancy — A systematic review and meta-analysis of studies published during — Coetzee A, Mason D, Hall DR, Conradie M. Prevalence and predictive factors of early postpartum diabetes among women with gestational diabetes in a single-center cohort.

Gynecol Obstet 1 — Azkoul A, Sim S, Lawrence V. Diabetic ketoacidosis in adults: part 1. Pathogen Diagnosis South Sudan Med. Kamalakannan D. Diabetic ketoacidosis in pregnancy. Postgrad Med. Perinatal outcomes of women with DKA during pregnancy. Obstet Gynecol 6 :S Morrison FJR, Movassaghian M, Seely EW, Curran A, Shubina M, Morton-Eggleston E, et al.

Fetal outcomes after diabetic ketoacidosis during pregnancy. Diabetes Care 40 7 :e77—9. Ng YHG, Ee TX, Kanagalingam D, Tan HK. Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis. BMJ Case Rep. Kilvert JA, Nicholson HO, Wright AD. Ketoacidosis in diabetic pregnancy.

Diabetes Med. Jaber JF, Standley M, Reddy R. Euglycemic diabetic ketoacidosis in pregnancy: A case report and review of current literature. Case Rep. Care —5. Parker JA, Conway DL.

Obstet Gynecol Clin. North Am. Eshkoli T, Barski L, Faingelernt Y, Jotkowitz A, Finkel-Oron A, Schwarzfuchs D. Diabetic ketoacidosis in pregnancy — Case series, pathophysiology, and review of the literature. Obstet Gynecol Reprod. Characteristics of young adults with multiple episodes of diabetic ketoacidosis.

Reddy Y, Ganie Y, Pillay K. Characteristics of children presenting with newly diagnosed type 1 diabetes. South Afr J. Child Health —8. Thomas S, Mohamed NA, Bhana S. Audit of diabetic ketoacidosis management at a tertiary hospital in Johannesburg, South Africa.

S Afr Med. Modi A, Agrawal A, Morgan F. Euglycemic diabetic ketoacidosis: A review. Diabetes Rev. Nasa P, Chaudhary S, Shrivastava PK, Singh A.

Euglycemic diabetic ketoacidosis: A missed diagnosis. World J. Diabetes 12 5 — WHO Consultation on Obesity Geneva S, Organization WH. Obesity : preventing and managing the global epidemic : report of a WHO consultation. Geneva, Switzerland: World Health Organization Google Scholar.

Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension 72 1 — Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, et al.

ISPAD Clinical Practice Consensus Guidelines Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Diabetes 23 7 — Dhatariya KK. The Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults—An updated guideline from the Joint British Diabetes Society for Inpatient Care.

Garcia de Alencar J, Wieblling da Silva G, Correa da Costa Ribeiro S, Marchini J, Neto R, Possolo de Souza H. Euglycemic diabetic ketoacidosis in pregnancy. cases Emerg. Delic-Sarac M, Mutevelic S, Karamehic J, Subasic D, Jukic T, Coric J, et al. ELISA test for analyzing of incidence of type 1 diabetes autoantibodies GAD and IA2 in children and adolescents.

Acta Inform Medica 24 1 —5. EUROIMMUN Package Catalogue Lübeck, Germany: Medizinische Labordiagnostika Benson CB, Doubilet PM.

Sonographic prediction of gestational age: accuracy of second- and third-trimester fetal measurements. Roentgenol 6 —7. Wegienka G, Baird DD. A comparison of recalled date of last menstrual period with prospectively recorded dates.

Womens Health 14 3 — Methods for Estimating the Due Date. World Health Organization. World Health Organization Diguisto C, Strachan MWJ, Churchill D, Ayman G, Knight M. A study of diabetic ketoacidosis in the pregnant population in the United Kingdom: Investigating the incidence, aetiology, management and outcomes.

Dhanasekaran M, Mohan S, Erickson D, Shah P, Szymanski LM, Vella A, et al. Baagar K, Aboudi A, Khaldi H, Alowinati B, Abou-Samra AB, et al. A three-year review of diabetic ketoacidosis in pregnancy—causes and outcomes.

Endocrine Practice Maseko NF, van Zyl D, Adam S. A year audit of pregnancies affected by diabetic ketoacidosis at the Pretoria Academic Complex.

Gynecol Obstet 3 — Dhanasekaran M, Mohan S, Egan A. Diabetic ketoacidosis in pregnancy: an overview of pathophysiology, management, and pregnancy outcomes. EMJ Diabetes Dhanasekaran M, Mohan S, Erickson D, Shah P, Szymanski L, Adrian V, et al.

Diabetic ketoacidosis in pregnancy: clinical risk factors, presentation, and outcomes. Grundlingh N, Zewotir TT, Roberts DJ, Manda S. Assessment of prevalence and risk factors of diabetes and pre-diabetes in South Africa.

Health Popul Nutr. Chan JCN, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, et al. One in seven insulin-treated patients in developing countries reported poor persistence with insulin therapy: real world evidence from the cross-sectional international diabetes management practices study IDMPS.

Paulsen C, Hall DR, Mason D, van de Vyver M, Coetzee A, Conradie M. Observations on glucose excursions with the use of a simple protocol for insulin, following antenatal betamethasone administration. Diabetes in Pregnancy Western Cape Guidelines.

Capte Town South Africa: Gestational Diabetes Diabetes Mellitus Type 2 Open Access Policy. General Information. Read and Publish Deal. Contact the journal. Strengthening biomedical communities to advance science and health.

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Contact EDMCR About EDMCR Scope Editorial board Societies For libraries Abstracting and indexing. Advanced Search Help. Authors: Hiromi Himuro Hiromi Himuro Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan Search for other papers by Hiromi Himuro in Current site Google Scholar PubMed Close.

Takashi Sugiyama Takashi Sugiyama Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan Search for other papers by Takashi Sugiyama in Current site Google Scholar PubMed Close.

Hidekazu Nishigori Hidekazu Nishigori Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan Search for other papers by Hidekazu Nishigori in Current site Google Scholar PubMed Close.

Masatoshi Saito Masatoshi Saito Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan Search for other papers by Masatoshi Saito in Current site Google Scholar PubMed Close.

Satoru Nagase Satoru Nagase Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan Search for other papers by Satoru Nagase in Current site Google Scholar PubMed Close. Junichi Sugawara Junichi Sugawara Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan Search for other papers by Junichi Sugawara in Current site Google Scholar PubMed Close.

Nobuo Yaegashi Nobuo Yaegashi Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan Search for other papers by Nobuo Yaegashi in Current site Google Scholar PubMed Close.

Article Type: Research Article Online Publication Date: 01 Apr Open access. Get Citation Alerts. Download PDF. Check for updates. Learning points The presence of DKA caused by the onset of diabetes should be considered, even if the patient shows normal glucose tolerance during the first trimester.

Summary Diabetic ketoacidosis DKA during pregnancy is a serious complication in both mother and fetus. Background Diabetic ketoacidosis DKA is an acute metabolic complication 1. Case presentation A year-old Japanese woman 3G2P in her 28th week of gestation presented with a 3-week history of general fatigue and increased thirst.

Treatment After diagnosis of DKA, treatment with saline and intensive insulin therapy was initiated immediately.

Figure 1 Clinical course. Outcome and follow-up After the ketoacidosis improved, she underwent diet therapy and intensive insulin therapy. Discussion It is unusual for women with a normal GTT in the first trimester to develop type 1 diabetes mellitus later on during pregnancy.

Declaration of interest The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Funding This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Patient consent Written informed consent was obtained from the patient. Author contribution statement All the authors have read the manuscript and have approved this article.

x PubMed Guo RX Yang LZ Li LX Zhao XP Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case—control study and a case report of euglycemic diabetic ketoacidosis in pregnancy.

x false. x PubMed Murabayashi N Sugiyama T Kihira C Kusaka H Sugihara T Sagawa N A case of fulminant type 1 diabetes mellitus associated with pregnancy.

Diabetes mellitus type 1. Diabetic ketoacidosis. Gestational diabetes mellitus. Asian - Japanese. Country of Treatment. Signs and Symptoms.

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