Objective:To investigate the clinical characteristics of diabetic ketoacidosis(DKA) during pregnancy.Methods:A retrospective chart review of 12 women who had been hospitalized with DKA during pregnancy in our hospital.Data of clinical manifestations and prognosis of these patients were obtained and studied.Results:Morbidity:The incidence of DKA during pregnancy was 0.36‰o(12/33084);1 cases was in the first trimester (8.3％),2 cases were in the second trimester(16.7％) and 9 cases were in the third trimester(75.0％);The incidence of pre-gestational diabetes mellitus(PGDM) and gestational diabetes mellitus(GDM) was 66.7％ (8/12),33.3％(4/12).12 cases were singleton pregnancies,natural pregnancy,not any preconception counseling or regular prenatal care.4 cases had the history of adverse pregnancy,4 cases were overweight before pregnancy,1 case had the history of hyperglycemia and 1 case had the family history of DM.12 cases did not conduct regular prenatal care and use sufficient amount of insulin;5 cases with infection (41.7％),3 cases with preeclampsia (25.0％),2 cases with dexamethasone to promote fetal lung maturity(16.6％),2 cases with threatened labor (16.6％),and 1 case with improper diet(8.3％).PH valuewas 7.050-7.319.BE value was-11.6--28.8.The average blood glucose value was 20.91 ±6.13 mmol/L.The average blood ketone value was 3.06 ± 1.44 mmoVL.The average glycohemoglobin (HbA1 c) value was (9.04 ± 2.09) ％.10 cases urine glucose were positive and 12 cases urine ketone were positive.All of them existed different degrees of electrolyte imbalance.The ketone in 12 cases were successfully turned to negativein 4-8 hours through insulin reducing blood glucose.3 cases occurred perinatal death and 1 case occurred inevitable abortion before hospitalization.8 cases continued to be pregnant after hospitalization,and 4 cases with termination of pregnancy due to pregnancy complications after DKA controlled 1-3 days,4 cases was mature delivery,all the 8 newborns werealive.Conclusions.The incidence of DKA increased accompany with gestational age.Compared to GDM,DKA is more often found in PGDM.The pregnancy women who suffered from DKA regularly existed different degrees of internal environmental disorders.The common reasons are non-standard use of insulin and infection.Women during gestational age with high-risk factor should screenand diagnosis routine,and management of diabetes for preventing DKA,which can improve the prognosis of maternal and neonatal.%目的:探讨妊娠合并糖尿病酮症酸中毒(DKA)的临床特征.方法:回顾性分析本院收治的资料完整的妊娠合并DKA 12例患者的临床特征和母儿结局.结果:本组妊娠合并DKA发病率0.36‰;发生在孕早期1例(8.3％)、孕中期2例(16.7％)、孕晚期9例(75.0％);孕前糖尿病(PG-DM)8例(66.7％),妊娠期糖尿病(GDM)4例(33.3％).12例均为单胎自然妊娠、均未进行孕前咨询及正规产检,有不良孕产史4例,孕前超重4例,既往血糖升高史1例,糖尿病家族史1例.12例均未规范产检且胰岛素用量不足;感染5例(41.7％),重度子痫前期3例(25.0％),地塞米松诱发2例(16.6％),先兆临产应激2例(16.6％),饮食不当1例(8.3％).实验室检查,pH值7.050～7.319,BE-11.6～-28.8,平均血糖20.91±6.13 mmol/L,平均血酮体3.06±1.44 mmol/L,平均糖化血红蛋白(HbAlc)为(9.04±2.09)％,10例患者尿糖阳性,12例患者尿酮体均为阳性,且均存在不同程度的电解质紊乱.12例患者均在4～8小时内成功酮体转阴,血糖控制达标.入院前就发生死胎者3例,难免流产1例;入院后仅8例继续妊娠,其中4例因妊娠合并症在DKA纠正后的1～3天终止妊娠,4例妊娠足月分娩,8例新生儿均存活.结论:妊娠合并DKA的发病率随孕周的增加而增加,PGDM比GDM者更易发生;患者存在不同程度的内环境紊乱及胰岛素使用不规范和感染.高危妇女应规范筛查并积极诊治糖尿病,早期识别并规范处置DKA,可获得良好的母儿预后.
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