Diabetic Ketoacidosis (DKA) in Pregnancy

Key points

• Diabetic ketoacidosis (DKA) is a medical emergency that carries a risk of serious morbidities and mortality.
• The rate of diabetes is increasing in the reproductive population.
• The incidence of DKA in pregnancy in the UK is currently not known.
• The aim of this study is to describe management and perinatal outcomes of affected pregnancies to inform current clinical practice and future research.

Surveillance period

1^st April 2019 – 30^th September 2020

Background

DKA in pregnancy is an infrequent complication of diabetes but one that nevertheless carries significant risks of morbidity and mortality for both mother and baby^[1]. Currently the estimated incidence of DKA in pregnancy is derived from figures in the general diabetic population, therefore the true rate of DKA in pregnancy is not known. The prevalence of diabetes (types 1 and 2) is increasing in the reproductive population, thus the complication is likely to become more common and hence improving the evidence-base for prevention and management is important. Clinicians caring for these women need to have accurate information with which to counsel them about the complication.

Objective

To use the UK Obstetric Surveillance System (UKOSS) to determine the incidence, risk factors, outcome and optimal management of women presenting with DKA during pregnancy in the UK.

Research questions

• What is the incidence of DKA in pregnancy?
• What are the main causes if DKA in pregnancy?
• How is DKA managed in the UK?
• What are the outcomes of DKA in pregnancy for women and their babies?
• Do the outcomes of pregnancy in women with DKA differ from the outcomes of women with diabetes without DKA?

Case definition

Any pregnant woman with diabetes (Types 1 & 2, MODY or GDM) who is admitted to hospital for the management of ketoacidosis (irrespective of the level of blood glucose).

This is a case-control study so controls will also be requested.

Funding

This study is being funded by the NIHR Research for Patient Benefit programme.

Ethics committee approval

This study has been approved by the North London REC1 (Ref. Number: 10/H0717/20).

Lead investigators

David Churchill and A Viswanath, New Cross Hospital, Wolverhampton; Lucy Mackillop, Oxford University Hospitals; Marian Knight, NPEU; M Strachan, Western General Hospital.

Sample Data Collection Form

UKOSS Diabetic Ketoacidosis Data Collection Form