Introduction: Diabetic ketoacidosis (DKA) in pregnancy is rare but associated with maternal and foetal morbidity and mortality. The objectives of this study were to evaluate the epidemiological, diagnostic, and progno...Introduction: Diabetic ketoacidosis (DKA) in pregnancy is rare but associated with maternal and foetal morbidity and mortality. The objectives of this study were to evaluate the epidemiological, diagnostic, and prognostic characteristics of DKA in pregnant women in Dakar hospitals and to study the predictive factors of its occurrence. Methods: This retrospective study was conducted from January 2013 to January 2021 in the Internal Medicine/ Endocrinology-Diabetology-Nutrition and Gynaecology-Obstetrics departments of the National University Hospital Centre in Pikine, Senegal. Medical files of all pregnant women hospitalised for DKA during this period were collected. Results: A total of 10 patients were included in the study. Average age was 30.9 years. Two patients with unplanned pregnancies had pre-gestational diabetes mellitus (pre-GDM) and did not have regular diabetic follow-up. Among the 8 patients with GDM, risk factors for GDM were found in 7 women, and three had a history of GDM. Blood glucose levels were >1.02 and >11 g/L for these two groups, respectively. None of the women had been systematically screened for GDM between 24 and 28 gestational weeks. Signs of ketosis were present: 6 patients had Kussmaul dyspnea and one patient had a Glasgow Coma Score of 10/15. The precipitating factor was infection in three patients. Two patients had pre-eclampsia. The evolution of DKA was favourable in all patients. For pregnancy outcomes: 4 cases of intrauterine foetal death were recorded, 2 women carried their pregnancy to term, a woman gives birth prematurely and 3 patients were lost to follow-up. Conclusion: DKA during pregnancy is rare in Dakar hospitals but health risk increases with the lack of screening for GDM in pregnant women, follow-up in a specialised environment, and pregnancy planning in diabetic patients. The obstetrical prognosis is poor for GDM patients, with a high rate of foetal death in utero.展开更多
文摘Introduction: Diabetic ketoacidosis (DKA) in pregnancy is rare but associated with maternal and foetal morbidity and mortality. The objectives of this study were to evaluate the epidemiological, diagnostic, and prognostic characteristics of DKA in pregnant women in Dakar hospitals and to study the predictive factors of its occurrence. Methods: This retrospective study was conducted from January 2013 to January 2021 in the Internal Medicine/ Endocrinology-Diabetology-Nutrition and Gynaecology-Obstetrics departments of the National University Hospital Centre in Pikine, Senegal. Medical files of all pregnant women hospitalised for DKA during this period were collected. Results: A total of 10 patients were included in the study. Average age was 30.9 years. Two patients with unplanned pregnancies had pre-gestational diabetes mellitus (pre-GDM) and did not have regular diabetic follow-up. Among the 8 patients with GDM, risk factors for GDM were found in 7 women, and three had a history of GDM. Blood glucose levels were >1.02 and >11 g/L for these two groups, respectively. None of the women had been systematically screened for GDM between 24 and 28 gestational weeks. Signs of ketosis were present: 6 patients had Kussmaul dyspnea and one patient had a Glasgow Coma Score of 10/15. The precipitating factor was infection in three patients. Two patients had pre-eclampsia. The evolution of DKA was favourable in all patients. For pregnancy outcomes: 4 cases of intrauterine foetal death were recorded, 2 women carried their pregnancy to term, a woman gives birth prematurely and 3 patients were lost to follow-up. Conclusion: DKA during pregnancy is rare in Dakar hospitals but health risk increases with the lack of screening for GDM in pregnant women, follow-up in a specialised environment, and pregnancy planning in diabetic patients. The obstetrical prognosis is poor for GDM patients, with a high rate of foetal death in utero.
