Acute triggers and long-term postpartum outcomes of diabetic ketoacidosis in pregnancy: a 7-case retrospective series

To investigate the clinical characteristics, acute triggers, and long-term maternal and fetal outcomes of gestational diabetic ketoacidosis (DKA). A retrospective analysis was performed on 7 pregnant women with DKA admitted to two tertiary hospitals from January 2018 to December 2025. Additionally, a long-term postpartum follow-up (range: 1.6–7.0 years; median: 5.3 years) was conducted to evaluate chronic complications and metabolic trajectories. Six cases occurred in the third trimester and one in the first. The primary iatrogenic trigger was dexamethasone administration for fetal lung maturation ( n = 3), followed by acute pancreatitis ( n = 3) and infection ( n = 1). Acidosis was corrected within 12–24 h via standardized resuscitation. While no maternal deaths occurred, three cases suffered adverse fetal outcomes (two stillbirths, one miscarriage). Postpartum follow-up of six successfully traced patients revealed persistent metabolic derangements in five women (83.3%), including one severe microvascular progression requiring cataract surgery and one case of complete therapeutic non-compliance. Gestational DKA is a critical obstetric emergency with high fetal mortality. Dexamethasone and lipid-induced pancreatitis are prominent triggers. Given the high rate of persistent postpartum metabolic derangements over long-term follow-up, prolonged multidisciplinary surveillance and stringent continuous glycemic education are mandatory.