BACKGROUND:
Diabetic ketoacidosis in pregnancy (DKP) can result in significant morbidity and possible mortality for both mother and fetus with incidence between 1-3% of pregnant T1DM. The fetal mortality rate has been documented at 9%, with maternal mortality estimated between 4-15%.
OBJECTIVES:
To examine the precipitating factors, laboratory results, treatments and perinatal outcomes in pregnancies complicated by DKA at a Tertiary Australian centre.
METHODS:
Retrospective cohort study of presentations with DKA in pregnant women between January 2002 and December 2017 at the Royal Brisbane and Womens’ Hospital, Queensland, Australia. The diagnosis was made by BSL >10.0mmol/L, presence of metabolic acidosis and ketones. Maternal and perinatal outcomes analysed.
RESULTS:
Total of 19 patients presented with DKA in pregnancy during this period. One of them presented twice in the same pregnancy. All of them were Type 1 diabetes. Most of them presented in the third trimester. One of them had a termination and another delivered vaginally. 68.46% were delivered by emergency caesarean section and 21.1% had elective CS. 26.2% did not have any postnatal complications and 52.6% had very labile BSLs and 2 of them had postnatal ketosis.
26.3% of the babies had lower Apgar at the 1st minute but the Apgars were above after 5 minute of birth. 3 babies had abnormal cord gases at birth. 25.1% of the babies were above 3.5 kg and the highest Birth weight was 4.4kg. Majority of the babies 89.5% babies were admitted to the Neonatal Intensive care Unit at least 1 day and also spent at least 2 days in the Special Care Baby Unit. All the babies suffered severe hypoglycaemia. There were no perinatal deaths or maternal deaths.
CONCLUSION:
This series did not have any significant adverse health outcomes to the mother or baby unlike previous series. This demonstrates the importance of early recognition and management of this rare medical emergency would optimise the maternal and perinatal outcome.