임신과 동반된 당뇨병성 케톤산혈증의 임상적 고찰 = Clinical Features of Diabetic Ketoacidosis in Pregnancy

다국어 초록 (Multilingual Abstract)

Several complications of pregnancy may occur with increased frequency in diabetic pregnancies including ketoacidosis. Pregnancy-induced lipolysis and ketone body production makes women more susceptible to diabetic ketoacidosis. The effect on the fetus of maternal ketoacidosis may be severe. If untreated, it may cause fetal death. We investigated our experience of the clinical features of diabetic ketoacidosis in 352 diabetic pregnancies.
We reviewed 352 cases of diabetic pregnancy during, the period from March, 1988 to February, 1997 retrospectively. An episode of ketoacidosis occurred during or immediately after the delivery in nine patients, representing 2.56 % of diabetic pregnancies.
The mean age of patients was 29.8±4.4^*(range 23-38) years. The mean duration of onset of diabetes was 4.83.±3.40^* years. Diabetes was controlled on insulin in all patients (30.4±1.8^* U/ D). Only two of all patients were nulliparous women and the others multiparous women. There was one spontaneous abortion at eighth week gestation, the remaining 8 fetus all survived. The mean weight of fetus was 3.34±0.79^*kg. The four of nine fetus were macrosomia(birth weight in excess of 4kg). On the past history, risk factors were associated with acute pyelonephritis and acute tonsillitis in two patients. In our cases, maternal acidosis was not severe. Levels of pH and HC03- were 7.17±0.11^* and 12.4±4.2^*(mEq/I). Initial level of blood glucose was 29.18±8.96^* nmol/1 and HbAlc was 10.28±11.27^*%. On the admission, the mean level of serum C-peptide was 1.04±0.72^*(nmol/L). In 28-year-old multiparous patient, initial level of serum C-peptide was 0.12 nmol/L and the other cases were higher than 0.4nmol/L.
In our cases, the levels of blood glucose and HbAlc in diabetic ketoacidosis patients were not higher than in the general population of diabetic pregnant women. All episode of ketoaeidosis was occurred during insulin therapy and a definite precipitating factor of ketoacidosis was identified in two patients. A classification of diabetes by the initial level of serum C-peptide, We suggest that one of nine patients can be classified as IDDM.(* mean ±SD)