Visual Abstract
Background: Insulin resistance in pregnancy may be related to ketone synthesis. Data on ketone production in pregnancy and whether they are associated with gestational diabetes (GDM) risk is limited.
Methods: A matched case-control study of 107 GDM cases and 214 controls was conducted within the NICHD Fetal Growth Studies-Singleton Cohort. Beta hydroxybutyrate (BOH, mmol/L) was measured 4 times in plasma collected at gestational weeks (GW) 10-14, 15-26 (fasted), 23-31, and 33-39. GDM diagnosis and glucose challenge test (GCT) results were extracted from medical records. Prevalence of undetectable (<0.1), detectable (0.1-<0.2), elevated (0.2-<0.4), and ketoacidosis (≥0.4) BOH were estimated irrespective of GDM. Prospective associations of BOH at GW 10-14 and 15-26 with GDM were estimated using conditional logistic regression; associations with GCT results were estimated using weighted linear regression with robust variance.
Results: Percent of women with undetectable, detectable, elevated, and ketoacidosis BOH was 41%, 47%, 10%, and 2% at GW 10-14; 37%, 46%, 15%, and 2% at GW 15-26; 48%, 43%, 9%, and 0% at GW 23-31; and 37%, 57%, 6%, 0% at GW 33-39. Ketoacidosis at 10-14 GW was associated with higher GCT levels (Table).
Conclusions: Although few women develop ketoacidosis in pregnancy, detectable ketone levels are common in pregnancy. First trimester ketoacidosis was prospectively associated with higher GCT glucose at GDM screening.
S. Hinkle: None. S. F. Yisahak: None. S. Zhao: None. M. Y. Tsai: None. C. Zhang: None.
Eunice Kennedy Shriver National Institute of Child Health and Human Development
