Opportunities to Improve Recognition of Diabetic Ketoacidosis in Pregnancy

The presence of ketosis and anion gap metabolic acidosis in individuals with diabetes indicates diabetic ketoacidosis (DKA). The incidental detection of such laboratory abnormalities in persons with diabetes should trigger an intentional evaluation for DKA. The objective of this retrospective cohort study was to assess the frequency with which pregnant individuals with diabetes and a laboratory abnormality potentially indicative of DKA underwent a complete laboratory assessment and to identify factors associated with completion of the appropriate laboratory testing. Clinical characteristics were evaluated for patients with complete and incomplete workups. Workup for DKA was completed in only 30.0% of individuals with laboratory evidence of acidosis or ketosis; 64.0% (57/89) of those with complete workups did not meet criteria for DKA. This study highlights opportunities to ensure complete laboratory workup for DKA, especially in patients with non-type 1 diabetes, obstetric conditions such as labor, and lower glucose on presentation.