OBJECTIVE: This report describes the physiologic alterations that predispose pregnant women to diabetic ketoacidosis and the experience in a tertiary center after adoption of aggressive management of diabetics. STUDY DESIGN: In 1982 a protocol for strict surveillance of glucose homeostasis for pregnant diabetic patients and the early recognition and aggressive treatment of patients who do have diabetic ketoacidosis was initiated and has resulted in improved maternal and neonatal outcomes. RESULTS: From 1986 through 1991 the incidence of diabetic ketoacidosis was 3% compared with an incidence of 22% from 1976 to 1981. During this same time the incidence of fetal death associated with diabetic ketoacidosis decreased from 35% to 10%. CONCLUSION: Diabetic ketoacidosis and fetal morbidity/mortality can be reduced by aggressive management during pregnancy.
OBJECTIVE: This report describes the physiologic alterations that predispose pregnant women to diabetic ketoacidosis and the experience in a tertiary center after adoption of aggressive management of diabetics. STUDY DESIGN: In 1982 a protocol for strict surveillance of glucose homeostasis for pregnant diabeticpatients and the early recognition and aggressive treatment of patients who do have diabetic ketoacidosis was initiated and has resulted in improved maternal and neonatal outcomes. RESULTS: From 1986 through 1991 the incidence of diabetic ketoacidosis was 3% compared with an incidence of 22% from 1976 to 1981. During this same time the incidence of fetal death associated with diabetic ketoacidosis decreased from 35% to 10%. CONCLUSION:Diabetic ketoacidosis and fetal morbidity/mortality can be reduced by aggressive management during pregnancy.