Endocrine Abstracts

Background: Ketosis during pregnancy can lead to serious maternal and fetal complications in patients with Type 1 Diabetes, including risk of miscarriage or still birth for the fetus and risk of maternal mortality. This project evaluates the prevalence of ketone testing in pregnant women with Type 1 Diabetes presenting to the emergency department (ED), the incidence of ketonemia and the associated pregnancy outcomes.

Methodology: A retrospective study was conducted from September 1, 2023, to August 31, 2024, involving 20 ED visits by 13 pregnant women with Type 1 Diabetes. Data, provided by the Business Intelligence team and anonymized for confidentiality, included maternal illness visits during pregnancy, blood ketone measurements, glucose readings, and pregnancy outcomes. The analysis focused on assessing whether appropriate actions were taken for levels exceeding 1.0.

Results: Among the 20 visits, ten women reported feeling unwell, six experienced per vaginal bleeding, three had musculoskeletal symptoms, and one presented with shortness of breath. Blood ketone levels were assessed in only 8 visits (40%),. Of those tested, 5 had ketones <1.0, and three had ketones >1.0. Four women had multiple ED visits, raising concerns about recurrent admissions. The three patients with elevated ketones were managed according to protocols, leading to one readmission with a premature birth at 36 weeks; two others experienced miscarriage.

Conclusion: The findings underscore the urgent need for enhanced monitoring of blood ketones in pregnant women with Type 1 Diabetes during illness.

Actions: Recommendations include prenatal educational reinforcement on ketone monitoring in illness among patients, enhancing communication among healthcare providers, and establishing clear protocols in ED and maternity settings. Educational initiatives, including posters and training sessions, are underway to address these barriers.