Diabetic Ketoacidosis in Pregnancy

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The University of Texas Health Science Center in San Antonio, San Antonio, TX 78229, USA.
Obstetrics and Gynecology Clinics of North America (Impact Factor: 1.38). 10/2007; 34(3):533-43, xii. DOI: 10.1016/j.ogc.2007.08.001
Source: PubMed


Episodes of diabetic ketoacidosis (DKA) can represent a life-threatening emergency for mother and fetus. The cornerstones of treatment of DKA are aggressive fluid replacement and insulin administration while ascertaining which precipitating factors brought about the current episode of DKA, and then treating accordingly to mitigate those factors. The incidence of DKA and factors unique to pregnancy are discussed in this article, along with the effects of the disease process on pregnancy. Clinical presentation, diagnosis, and treatment modalities are covered in detail to offer ideas to improve maternal and fetal outcome.

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    ABSTRACT: Optimal maternal, fetal, and neonatal outcomes are the goal of care for pregnant women with preexisting diabetes. Women with a long history of poorly managed diabetes begin pregnancy with a deficit that poses additional challenges for the patient and the healthcare team. The following case study presents a woman who had a history of type 1 diabetes that was poorly controlled and experienced an incidence of severe hypoglycemia with serious sequelae.
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    ABSTRACT: Pregnant women with diabetes have to manage both the effect of pregnancy on glucose control and its effect on pre-existing diabetic complications. Most women experience hypoglycaemia as a consequence of tightened glycaemic control and this impacts on daily living. Less commonly, diabetic ketoacidosis, a serious metabolic decompensation of diabetic control and a medical emergency, can cause foetal and maternal mortality. Microvascular complications of diabetes include retinopathy and nephropathy. Retinopathy can deteriorate during pregnancy; hence, regular routine examination is required and, if indicated, ophthalmological input. Diabetic nephropathy significantly increases the risk of obstetric complications and impacts on foetal outcomes. Pregnancy outcome is closely related to pre-pregnancy renal function. Diabetic pregnancy is contraindicated if the maternal complications of ischaemic heart disease or diabetic gastropathy are known to be present before pregnancy as there is a significant maternal mortality associated with both of these conditions.
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