Fetal Mortality in Pregnancy Complicated by Diabetic Ketoacidosis Prevalence and Outcome at Emergency Department

Abstract

Background: Diabetic ketoacidosis during pregnancy is an uncommon but serious metabolic emergency associated with substantial fetal risk despite improved maternal survival. Pregnancy-related insulin resistance, reduced buffering capacity, dehydration, ketonemia, and metabolic acidosis may rapidly compromise uteroplacental perfusion and fetal oxygenation. Objective: To determine fetal mortality and maternal outcomes among pregnant women presenting with diabetic ketoacidosis to the Emergency Department of Lady Reading Hospital, Peshawar. Methods: This prospective observational study was conducted from 1st July 2025 to 30th December 2025 after ethical approval. Pregnant women with diabetic ketoacidosis in any trimester were enrolled using non-probability consecutive sampling. Demographic, obstetric, clinical, laboratory, treatment, and outcome data were analyzed using SPSS version 27.0. The primary outcome was fetal mortality during the same hospital admission. Results: A total of 62 patients were included. Mean age was 28.9 ± 5.4 years, and mean gestational age was 29.6 ± 6.8 weeks. Fetal mortality occurred in 13 patients (21.0%), while maternal mortality occurred in 2 patients (3.2%). Intensive care unit admission was required in 21 patients (33.9%), and mechanical ventilation in 8 patients (12.9%). Severe metabolic acidosis and altered mental status independently predicted fetal mortality, with adjusted odds ratios of 3.84 and 3.21, respectively. Conclusion: Diabetic ketoacidosis during pregnancy is associated with considerable fetal mortality. Severe acidosis and altered mental status should prompt urgent multidisciplinary escalation.