Surge in DKA During Delivery Sparks Concerns for Maternal and Fetal Health in Pregestational Diabetes Cases: Study

"Diabetic ketoacidosis is linked to a higher risk of maternal complications and negative pregnancy outcomes. The risk factors for DKA during delivery are similar to those associated with DKA in the antepartum and postpartum periods," the researchers wrote.

Diabetic ketoacidosis, a serious complication characterized by high blood glucose levels and the accumulation of ketones in the blood, poses significant risks for both mothers and their babies. Kartik K Venkatesh, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The Ohio State University, Columbus, OH, and colleagues aimed to evaluate the frequency, risk factors, and adverse outcomes related to diabetic ketoacidosis (DKA) during delivery hospitalizations in individuals with pregestational diabetes (types 1 and 2). Additionally, they assessed the frequency and risk factors associated with antepartum and postpartum hospitalizations for DKA.

For this purpose, they conducted a serial, cross-sectional study utilizing the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2010 to 2020, focusing on pregnant individuals with pregestational diabetes who were hospitalized for delivery. The study examined two main exposures: 1) sociodemographic and clinical risk factors for DKA and 2) the occurrence of DKA itself.

The primary outcomes assessed included DKA during delivery hospitalization, maternal morbidity (such as severe maternal morbidity excluding transfusions, critical care procedures, cardiac complications, acute renal failure, and transfusions), and adverse pregnancy outcomes (including preterm birth, hypertensive disorders of pregnancy, and cesarean delivery). Additionally, the study evaluated secondary outcomes related to DKA during antepartum and postpartum hospitalizations.

The study led to the following findings:

• Of 392,796 deliveries in individuals with pregestational diabetes (27.2% type 1 diabetes, 72.8% type 2 diabetes), there were 4,778 cases of DKA at delivery hospitalization (89.1% type 1 diabetes, 10.9% type 2 diabetes).
• The frequency of DKA at delivery hospitalization was 1.2% (4.0% with type 1 diabetes, 0.2% with type 2 diabetes), and the mean annual percentage change was 10.8%.
• Diabetic ketoacidosis at delivery hospitalization was significantly more likely among those who had type 1 diabetes compared with those with type 2 diabetes, who were younger, who delivered at larger and metropolitan hospitals, and who had Medicaid insurance, lower income, multiple gestations, and prior psychiatric illness.
• Diabetic ketoacidosis during the delivery hospitalization was associated with an increased risk of non transfusion SMM (20.8% versus 2.4%), critical care procedures (7.3% versus 0.4%), cardiac complications (7.8% versus 0.8%), acute renal failure (12.3% versus 0.7%), and transfusion (6.2% versus 2.2%), as well as preterm birth (31.9% versus 13.5%) and hypertensive disorders of pregnancy (37.4% versus 28.1%).
• In secondary analyses, the overall frequency of antepartum DKA was 3.1%, and the mean annual percentage change was 4.1%; the overall frequency of postpartum DKA was 0.4%, and the mean annual percentage change was 3.5%.
• Of 3,092 antepartum hospitalizations among individuals with DKA, 15.7% had a recurrent case of DKA at delivery hospitalization.
• Of 1,419 postpartum hospitalizations among individuals with DKA, 20.0% previously had DKA at delivery hospitalization.
• The above risk factors for DKA at delivery hospitalization were similar for DKA at antepartum and postpartum hospitalizations.

"Between 2010 and 2020, the incidence of diabetic ketoacidosis at delivery increased, with an average annual percentage change of 10.8%. Additionally, cases of DKA during prenatal and postpartum periods also saw an upward trend during this time," the researchers concluded.

Reference:

Wen, Timothy MD, MPH; Friedman, Alexander M. MD, MPH; Gyamfi-Bannerman, Cynthia MD, MS; Powe, Camille E. MD; Sobhani, Nasim C. MD, MAS; Ramos, Gladys A. MD; Gabbe, Steven MD; Landon, Mark B. MD; Grobman, William A. MD, MBA; Venkatesh, Kartik K. MD, PhD. Diabetic Ketoacidosis and Adverse Outcomes Among Pregnant Individuals With Pregestational Diabetes in the United States, 2010–2020. Obstetrics & Gynecology ():10.1097/AOG.0000000000005667, July 11, 2024. | DOI: 10.1097/AOG.0000000000005667