Diabetic ketoacidosis

Pregnant women are prone to ketosis, so diabetic ketoacidosis (DKA) can occur at lower blood glucose concentrations during pregnancy. Predisposing factors for DKA in pregnancy include:

• infection
• omission of insulin dose(s)
• disruption of insulin delivery by an insulin infusion pump (for causes, see Disruption of pump–delivered subcutaneous insulin)
• drugs such as terbutaline (used to stop preterm labour) or glucocorticoids (used to induce fetal lung maturity).

DKA is a medical emergency and can cause perinatal morbidity and mortality—seek immediate specialist advice. Management involves consideration of the effects of DKA and its treatment on both the mother and the fetus. Hyperglycaemia should be treated promptly with hydration, intravenous insulin and correction of electrolyte abnormalities. Fetal monitoring is essential.

For further information on diabetic ketoacidosis, see Diabetic ketoacidosis.