Abstract
Purpose of Review
To review the unique pathophysiology, diagnostic challenges, clinical management, and prevention strategies of diabetic ketoacidosis (DKA) in pregnancy, with an emphasis on maternal and fetal outcomes and the importance of early recognition and intervention.
Recent Findings
Pregnancy-associated metabolic changes, including increased insulin resistance and reduced buffering capacity, lower the threshold for DKA development and contribute to atypical presentations such as euglycemic DKA. Recent updates from the American Diabetes Association have revised diagnostic criteria to better capture these nuances, including recognizing prior diabetes history as part of hyperglycemia criteria. Studies have shown that betamethasone administration, infection, and emesis are common precipitating factors, and that serum beta-hydroxybutyrate is a more reliable diagnostic marker than urine ketones. Balanced fluids such as Lactated Ringer’s may shorten recovery time compared to normal saline. Despite advances, DKA in pregnancy remains associated with high rates of preterm delivery and adverse neonatal outcomes.
Summary
Diabetic ketoacidosis during pregnancy is a rare but critical complication requiring rapid recognition and multidisciplinary management. Physiologic changes of pregnancy mask traditional warning signs and increase susceptibility to DKA, even at normal glucose levels. Accurate diagnosis and prompt treatment with fluids, insulin, and electrolyte correction can improve outcomes, but prevention remains paramount. Strategies such as early diabetes screening, preconception counseling, and patient education on sick day protocols are essential to mitigate the risks of DKA and improve maternal and fetal health.