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Diabetes

Poster Session 3

(737) Trends and Outcomes Among Pregnancy and non- Pregnancy Related Hospitalizations with Diabetic Ketoacidosis

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Ghamar Bitar, MD

    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

    • Coauthor(s)

  • HC

    Han-Yang Chen, PhD

    Department of Obstetrics, Gynecology and Reproductive Sciences
    The University of Texas Health Science Center at Houston
    Houston, TX, United States

  • Sarah Nazeer, MD (she/her/hers)

    Maternal-Fetal Medicine Fellow
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Suneet P. Chauhan, MD

    Professor
    University of Texas-Houston Medical School
    Houston, TX, United States

  • SB

    Sean C. Blackwell, MD

    Professor
    Children's Memorial Hermann Hospital
    Houston, TX, United States

  • Baha M. Sibai, MD

    Professor
    Hermann Memorial Hospital
    Houston, TX, United States

  • Michal Fishel Bartal, MD (she/her/hers)

    Maternal Fetal Medicine Faculty
    McGovern Medical School at UTHealth Houston, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Houston, TX, United States

Objective: To evaluate temporal trends and outcomes related to diabetic ketoacidosis (DKA) in pregnancy and ascertain if it is associated with a higher rate of adverse outcomes than in non- pregnant reproductive age persons with DKA.

Study Design:

We conducted a retrospective cross-sectional study using the National Inpatient Sample to identify hospitalizations with DKA among reproductive age women (15-49 years) in the U.S. (2016-2020). DKA in pregnancy hospitalizations was compared to DKA in non- pregnant hospitalizations. Adverse outcomes evaluated included mechanical ventilation, coma, seizures, renal failure, prolonged hospital stay and death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risk (aRR) and 95% confidence interval (CI). Annual percent change (APC) was used to calculate change in DKA over time.


Results: Among 35, 210,711 hospitalizations in reproductive age women, 447,600 (0.3%) were hospitalized with DKA. Of these, 13,390 (3%) hospitalizations occurred during pregnancy. Baseline characteristics differed in age, race and ethnicity, primary payer, household income, smoking status, location and teaching status of hospital, region of hospital bed size of hospital, heart disease, and baseline complications of diabetes. After adjustment, except for prolonged hospital stay, all adverse outcomes were more likely in non-pregnant DKA hospitalizations than in pregnant DKA hospitalizations (Table). Pregnancy related DKA hospitalizations were associated with a high rate of adverse outcomes including 12.5% renal failure, 2.1% seizures, 0.9% coma, and 0.2% mortality (Table). The rate of DKA increased over time (APC 3.8%, 95% CI 1.5 – 6.1), due to an increase in non-pregnancy related DKA (APC 4.7%, 95% CI 1.8 – 7.7).

Conclusion: A nationally representative sample of hospitalizations indicates higher risk of adverse outcomes in non-pregnancy related DKA hospitalizations as compared to pregnancy related DKA hospitalizations. DKA in pregnancy occurs at a rate of 68 per 100,000 hospitalizations with substantial adverse outcomes, including 0.2% mortality.