Trends and Outcomes among Pregnancy and Nonpregnancy-Related Hospitalizations with Diabetic Ketoacidosis

Ghamar Bitar; Baha M. Sibai; Han-Yang Chen; Sarah A. Nazeer; Suneet P. Chauhan; Sean Blackwell; Michal Fishel Bartal

doi:10.1055/a-2334-8692

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(02): 164-170
DOI: 10.1055/a-2334-8692

Original Article

Trends and Outcomes among Pregnancy and Nonpregnancy-Related Hospitalizations with Diabetic Ketoacidosis

Ghamar Bitar

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Baha M. Sibai

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Han-Yang Chen

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Sarah A. Nazeer

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Suneet P. Chauhan

²Delaware Center of Maternal-Fetal Medicine of ChristianaCare, Newark, Delaware

,

Sean Blackwell

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Michal Fishel Bartal

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

³Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

› Author Affiliations

Abstract

Objective The study's primary objective was to evaluate adverse outcomes among reproductive-age hospitalizations with diabetic ketoacidosis (DKA), comparing those that are pregnancy-related versus nonpregnancy-related and evaluating temporal trends.

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 United States (2016–2020). DKA in pregnancy hospitalizations was compared with DKA in nonpregnant hospitalizations. Adverse outcomes evaluated included mechanical ventilation, coma, seizures, renal failure, prolonged hospital stay, and in-hospital 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 the change in DKA rate over time.

Results Among 35,210,711 hospitalizations of reproductive-age women, 447,600 (1.2%) were hospitalized with DKA, and among them, 13,390 (3%) hospitalizations were pregnancy-related. The rate of nonpregnancy-related DKA hospitalizations increased over time (APC = 3.8%, 95% CI = 1.5–6.1). After multivariable adjustment, compared with pregnancy-related hospitalizations with DKA, the rates of mechanical ventilation (aRR = 1.56, 95% CI = 1.18–2.06), seizures (aRR = 2.26, 95% CI = 1.72–2.97), renal failure (aRR = 2.26, 95% CI = 2.05–2.50), coma (aRR = 2.53, 95% CI = 1.68–3.83), and in-hospital death (aRR = 2.38, 95% CI = 1.06–5.36) were higher among nonpregnancy-related hospitalizations with DKA.

Conclusion A nationally representative sample of hospitalizations indicates that over the 5-year period, the rate of nonpregnancy-related DKA hospitalizations increased among reproductive age women, and a higher risk of adverse outcomes was observed when compared with pregnancy-related DKA hospitalizations.

Key Points

Over 5 years, the rate of pregnancy-related DKA hospitalizations was stable.
Over 5 years, the rate of nonpregnancy-related DKA hospitalizations increased.
There is a higher risk of adverse outcomes with DKA outside of pregnancy.

Keywords

pregnancy - diabetic ketoacidosis - obstetric complications - diabetes

Full Text

References

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Supplementary Material

Supplementary Material