Diabetic Ketoacidosis in Pregnancy: Clinical Triggers, Outcomes, and Missed Opportunities—A Case Series
https://doi.org/10.15605/jafes.041.S1
- Author:
Jia Whey Jacelyn Ong
1
;
Chin Voon Tong
1
;
Raja Nurazni binti Raja Azwan
2
;
Adilah Zulaikha binti Abd Latib
2
;
Hidayatil Alimi bin Keya Nordin
2
;
Qin Zhi Lee
2
;
Kean Heng Lim
2
;
Jia Ling Low
2
;
Mohd Fyzal bin Bahrudin
2
;
Syaza binti Izhar Hisham
2
;
Liang Wei Wong
2
;
Lisa Mohamed Nor
1
;
Nurain Mohd Noorr
1
Author Information
1. Clinical Research Centre, Hospital Putrajaya
2. Endocrine Unit, Medical Department, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Female;
Pregnancy;
Diabetic Ketoacidosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):48-49
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Diabetic ketoacidosis (DKA) in pregnancy is an uncommon
yet life-threatening emergency, with disproportionate risks
to both mother and fetus. Pregnancy-specific physiological changes predispose patients to rapid metabolic decompensation, often with atypical presentations. Despite
this, local data remain limited. We describe the clinical
profile, precipitating factors, and outcomes of DKA in
pregnancy in a tertiary centre, with emphasis on potentially
preventable triggers.
Cases:Nine pregnant patients with DKA were identified from a
retrospective review of all cases admitted for DKA from
2002 to 2025. Mean age was 31.67 ± 5.20 years; all were
Malay. The majority had type 2 diabetes mellitus (55.6%),
followed by type 1 diabetes (33.3%) and latent autoimmune
diabetes in adults (11.1%). The mean period of amenorrhea
was 19.67 ± 12.62 weeks.
Infection was the leading precipitant (44.4%), with
additional triggers including insulin omission (22.2%),
hyperemesis gravidarum, preterm labor, steroid exposure,
and perioperative fasting. Most diagnoses were made in
the emergency department (55.6%).
Biochemical parameters reflected significant severity (mean
bicarbonate 7.89 ± 2.98 mmol/L; anion gap 25.00 ± 5.81),
with 88.9% classified as severe DKA. Intensive Care Unit
(ICU) care was required in 77.8% of cases. The majority
(77.8%) were admitted to the ICU unit, with a median time
to resolution of 13.00 ± 12.00 hours (interquartile range
[IQR]), and the median hospital length of stay was 7.00 ±
5.00 days (IQR).
Complications during treatment included hypokalemia
(33.3%), acute kidney injury (22.2%), and hypoglycemia
(11.1%). Rebound DKA occurred in one-third of patients.
All patients were discharged clinically stable. Outcome
data demonstrated pregnancy loss in three cases and one
preterm birth.
Conclusion:DKA in pregnancy remains a severe and resource-intensive
condition. This series highlights missed opportunities in
prevention, with modifiable precipitants such as infection
and insulin omission commonly identified. The high
severity at presentation suggests delays in recognition.
Early detection, optimized metabolic care, and targeted
preventive strategies are crucial to improving maternal
and fetal outcomes.
- Full text:2026073011433437272EP_A053.pdf
