Ketosis in pregnancy is a state in which the body burns fat for energy and makes ketones. It can happen when a pregnant person does not eat enough, vomits a lot, or has diabetes that is not well controlled.
The body normally uses glucose (sugar) for energy. When it cannot get or use enough glucose, it breaks down fat and makes ketones instead. In pregnancy this can happen after long gaps between meals, with severe vomiting such as hyperemesis gravidarum, with very restrictive dieting, or when diabetes, including gestational diabetes, is not well controlled.
Mild ketosis after a missed meal is usually short-lived. Higher or long-lasting levels are more of a concern, and dieting is generally not advised during pregnancy. In people with diabetes, high ketone levels can lead to diabetic ketoacidosis (DKA), a serious condition that needs urgent hospital treatment.
Possible signs include feeling very thirsty, passing more urine, nausea and vomiting, tummy pain, tiredness, confusion, and breath that smells fruity. Ketones can be measured with a urine or blood test. Anyone who is pregnant and has these symptoms, especially with diabetes, should contact their midwife, doctor or maternity unit promptly.
Management depends on the cause. Advice often focuses on regular meals and snacks with enough carbohydrate, and on drinking enough fluids. Severe vomiting or DKA may need treatment in hospital, for example with fluids through a drip. Pregnant people with diabetes usually get specific guidance from their care team on when and how to check ketones.
Sources: NHS, NHS, MedlinePlus.
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