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Peer-reviewedCC BY-NC-NDBMC pregnancy and childbirth

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

  • Ya-Li Yang1,2,3
  • Qiao-Fang Yang4,5
  • Xu-Fei Fan4,6,5
6 affiliations
  1. 1Jinhua Maternal and Child Health Care Hospital, Jinhua, Zhejiang, China. [email protected].
  2. 2Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China. [email protected].
  3. 3Jinhua's Key Laboratory of Comprehensive Prevention and Treatment of Birth Defects, Jinhua, Zhejiang, China. [email protected].
  4. 4Jinhua Maternal and Child Health Care Hospital, Jinhua, Zhejiang, China.
  5. 5Jinhua's Key Laboratory of Comprehensive Prevention and Treatment of Birth Defects, Jinhua, Zhejiang, China.
  6. 6Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China.
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Abstract

Objective

To investigate the clinical characteristics, acute triggers, and long-term maternal and fetal outcomes of gestational diabetic ketoacidosis (DKA).Methods

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.Results

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.Conclusion

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.

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Cite

BibTeXRIS
BibTeX
@article{yang2026acute,
  title = {{Acute triggers and long-term postpartum outcomes of diabetic ketoacidosis in pregnancy: a 7-case retrospective series.}},
  author = {Ya-Li Yang and Qiao-Fang Yang and Xu-Fei Fan},
  journal = {BMC pregnancy and childbirth},
  year = {2026},
  month = jul,
  doi = {10.1186/s12884-026-09732-8},
  url = {https://europepmc.org/article/MED/42907800},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Acute triggers and long-term postpartum outcomes of diabetic ketoacidosis in pregnancy: a 7-case retrospective series.
AU  - Ya-Li Yang
AU  - Qiao-Fang Yang
AU  - Xu-Fei Fan
PY  - 2026
DA  - 2026/07/01
JO  - BMC pregnancy and childbirth
DO  - 10.1186/s12884-026-09732-8
UR  - https://europepmc.org/article/MED/42907800
AB  - Objective  To investigate the clinical characteristics, acute triggers, and long-term maternal and fetal outcomes of gestational diabetic ketoacidosis (DKA).Methods  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.Results  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.Conclusion  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.
SN  - 1471-2393
ER  -