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Could Blood Ketone Monitoring Be A Tool for Managing Gestational Diabetes Mellitus?

¹ University Medical Center, Bordeaux, France
² University Medical Center, Lille, France
³ University Medical Center, Angers, France

Address correspondence to Prof. Henri Gin, Hôpital du Haut Lèveêque, F-33604 Pessac, France. Email: henri.gin{at}chu-bordeaux.fr

Nutritional management of gestational diabetes mellitus (GDM) is based on guidelines from diabetology societies (1). Ketonuria is often monitored, but clear management guidelines have not been established. Home-based methods of measuring ketonemia are available. We believe that it is important to evaluate the utility of this tool in GDM.

We measured ketonemia in a control population of pregnant women and a GDM population. Pregnant women were systematically screened for GDM between the 24th and 28th weeks (75-g oral glucose tolerance test [OGTT], World Health Organization guidelines). A total of 56 women (29.98 ± 4.86 years of age, prepregnancy BMI 23.14 ± 4.62 kg/m², weight gain 14.49 ± 4.93 kg) with a normal OGTT and 49 women (31.35 ± 5.39 years, prepregnancy BMI 25.96 ± 5.91 kg/m², weight gain 9.25 ± 5.52 kg) with GDM were included.

Each subject was monitored in accordance with the appropriate guidelines; in addition, the control subjects performed glycemia and ketonemia self-monitoring three times a day (upon waking and before the midday and evening meals). GDM women were also asked to measure their postprandial glycemia. All subjects measured their fasting ketonuria.

Glycemia measurement was performed using test strips and a meter (Abbott), and capillary blood ketonemia measurement was performed using Optium ß-Ketone test strips and the same meter (2). The replicate analysis resulted in CVs of 3.3%. The study protocol was approved by an ethics committee.

The two groups did not differ in terms of age, but BMI and weight gain were higher in the GDM than in the control group (P < 0.01). The mean ketonemia was lower in the control than in the GDM group (0.01 ± 0.10 vs. 0.04 ± 0.009 mmol/l, P < 0.001). Fasting ketonemia did not differ between the control and GDM groups (0.01 ± 0.11 vs. 0.01 ± 0.06 mmol/l, respectively). Ketonemia values measured before the midday and the evening meal were lower for control than for GDM patients (midday 0.01 ± 0.08 vs. 0.05 ± 0.11 mmol/l, P = 0.002; evening 0.02 ± 0.09 vs. 0.05 ± 0.10 mmol/l, P = 0.005).

A ketonemic episode was defined as the unbroken period during which each day is a part of a sliding 7-day interval containing >25% of height value. Of the control subjects, 6 (12%) experienced at least one ketonemic episode (average length 10.5 days) versus 23 (47%) in the GDM group (average length 13.8 days) (a total of 37 episodes).

For women with GDM, we are not currently in a position to conclude whether their ketonemia levels have clinical significance in terms of the pregnancy outcome or the health of the child. Ketonemia values differ from those recorded in control subjects, and this difference is not irrelevant. A study needs to be performed to be certain that higher ketonemia has a detrimental prognostic significance for fetal development.

Reports from the literature have focused exclusively on ketonuria. A negative correlation between ketonuria and intellectual quotient in children born to diabetic mothers has been reported (3,4). A relationship between high fasting ketonemia during the last trimester and delayed educational development has been suggested (5).

References

1. American Diabetes Association: Gestational diabetes mellitus (Position Statement). Diabetes Care 26(Suppl. 1):S103–S105, 2003
   
2. Byrne HA, Tiezen KL, Hollys S, Dornan TL, New JP: Evaluation of an electrochemical sensor for measuring blood ketones. Diabetes Care 23:500–503, 2000[Abstract]
   
3. Churchill JA, Berendes HW, Nemore J: Neuropsychological deficits in children of diabetic mother. Am J Obst Gynecol 105:257–268, 1969[Medline]
   
4. Stehbens JA, Baker GL, Kitchel M: Outcome at ages 1, 3, and 5 years of children born to diabetic women. Am J Obstet Gynecol 127:408–413, 1977[Medline]
   
5. Jovanovic L, Metzger BE, Knopp R, Conley MR, Park E, Lee YJ, Simpson JL, Holmes L, Aarons JH, Mills JL, the Diabetes in Early Pregnancy Study Group: The Diabetes in Early Pregnancy study: ß-hydroxybutyrate levels in type 1 diabetic pregnancy compared with normal pregnancy. Diabetes Care 21:1978–1984, 1998[Abstract]
   

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This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gin, H. Search for Related Content PubMed PubMed Citation Articles by Gin, H. Social Bookmarking                What's this?