Stathi Dimitra, Lee Florence Ning, Dhar Mili, Bobotis Stergios, Arsenaki Elisavet, Agrawal Taruna, Triantafyllidis Konstantinos Katsikas, Kechagias Konstantinos S
Department of Endocrinology and Diabetes, King's College Hospital NHS Trust, London, UK.
Department of Endocrinology and Diabetes, St Bartholomew's Hospital, London, UK.
Clin Med Insights Endocrinol Diabetes. 2025 Jan 15;18:11795514241312849. doi: 10.1177/11795514241312849. eCollection 2025.
Diabetic ketoacidosis (DKA) is a rare but serious complication that can develop during pregnancy, with up to 30% of patients presenting with euglycemia, making prompt recognition challenging. It is associated with increased perinatal mortality rates, although the exact risk of maternal mortality remains unclear. The purpose of this systematic review was to examine the available literature and provide an overview of reported cases of DKA during pregnancy.
PubMed, Web of Science and Scopus library databases were screened from inception until January 2024. Included studies provided data on classic or euglycemic DKA during pregnancy. All study designs were considered eligible for inclusion.
We identified 66 eligible articles, which included 57 case reports and case series with individual patient data, and 9 studies without individual patient data. The mean age at diagnosis was 28.8 years, and the average gestational age at diagnosis was 29.5 weeks. The majority of women had type 1 diabetes mellitus (T1DM) (45.9%), followed by gestational diabetes (GDM) (40.5%). Most cases were classified as classic DKA (70.3%), with nearly one-third developing euglycemic DKA (29.7%). The most common trigger factors were infections (28%), followed by poor adherence to treatment (13.5%). The most frequent symptoms included nausea (32.4%), vomiting (32.4%), osmotic symptoms (21.6%), and abdominal pain (20.2%). All cases were treated with intravenous insulin and fluids. The vast majority (98.9%) of women eventually fully recovered, with only 1 reported death due to organ failure (1.3%). Intrauterine death or stillbirth occurred in one-third of cases (35.2%), including 1 instance of a twin pregnancy.
DKA is a condition that clinicians may encounter during pregnancy. Although rare, increased awareness and early recognition are crucial for optimal management and improved maternal and neonatal outcomes.
糖尿病酮症酸中毒（DKA）是一种在孕期可能发生的罕见但严重的并发症，高达30%的患者血糖正常，这使得及时识别具有挑战性。它与围产期死亡率增加有关，尽管孕产妇死亡的确切风险尚不清楚。本系统评价的目的是研究现有文献，并概述孕期DKA的报告病例。
对PubMed、科学网和Scopus图书馆数据库从创建到2024年1月进行筛选。纳入的研究提供了孕期经典或血糖正常的DKA数据。所有研究设计均被认为符合纳入条件。
我们确定了66篇符合条件的文章，其中包括57篇病例报告和带有个体患者数据的病例系列，以及9篇无个体患者数据的研究。诊断时的平均年龄为28.8岁，诊断时的平均孕周为29.5周。大多数女性患有1型糖尿病（T1DM）（45.9%），其次是妊娠期糖尿病（GDM）（40.5%）。大多数病例被分类为经典DKA（70.3%），近三分之一发展为血糖正常的DKA（29.7%）。最常见的触发因素是感染（28%），其次是治疗依从性差（13.5%）。最常见的症状包括恶心（32.4%）、呕吐（32.4%）、渗透性症状（21.6%）和腹痛（20.2%）。所有病例均接受静脉注射胰岛素和补液治疗。绝大多数（98.9%）女性最终完全康复，仅报告1例因器官衰竭死亡（1.3%）。三分之一的病例（35.2%）发生宫内死亡或死产，包括1例双胎妊娠。
DKA是临床医生在孕期可能遇到的一种情况。虽然罕见，但提高认识和早期识别对于优化管理以及改善孕产妇和新生儿结局至关重要。
