Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Prevalence of ketonuria in pregnancy (#115)

Helen L Robinson 1 2 3 , Helen L Barrett 1 2 3 , Katie F Foxcroft , Leonie K Callaway 1 2 3 , Marloes Dekker Nitert 1 2
  1. UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
  2. School of Medicine, The University of Queensland, Herston, QLD, Australia
  3. Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia

Background: Elevated maternal ketone levels have been associated with adverse pregnancy outcomes(1, 2). Ketogenesis is accelerated in pregnancy, particularly in the third trimester(3). There is a paucity of information in the literature regarding the prevalence of elevated maternal ketone levels. Of the studies that do report on the prevalence, there is wide variation ranging from a prevalence of 9% to 89%(2, 4).

Aims and Methods: The aim of the study was to determine the prevalence of maternal ketonuria at the end of the first trimester, second trimester and during the third trimester. Women enrolled in the SPRING study, a study of probiotics in pregnancy, had fasting urine samples tested at 16 and 28 weeks gestation(5). The presence of ketonuria was measured via urine dipstick testing for all patients enrolled at the Royal Brisbane and Women’s Hospital. After delivery, hospital charts were reviewed to determine the rates of ketonuria in the third trimester.

Results: At 16 weeks gestation, 17/145 (12%) women had any detectable amount of ketones in their urine defined as trace amounts (0.5 mmol/L) or more. Six women had levels of ketonuria of +1 (1.5mmol/L) or more (6/145, 4%). At 28 weeks gestation, 14/123 (11%) women had any detectable amount of ketones in their urine and 7 had +1 or more (7/123, 6%). Of the women who had urine ketone levels recorded in the third trimester, 13/79 (16%) had any detectable amount of ketones in their urine and 10 had +1 or more (10/79, 13%).

Conclusion: This study showed that the prevalence of elevated maternal ketone levels in the third trimester is at least double the prevalence in the first and second trimesters. One in eight women in the third trimester had a ketone level of +1 or more. This finding potentially has important clinical implications in terms of identifying women at risk of adverse pregnancy outcomes. 

  1. Churchill JA, Berendes HW 1969 Intelligence of children whose mothers had acetonuria during pregnancy. Perinatal factors affecting human development 185:30-35.
  2. Hamdi K, Bastani P, Gafarieh R, Mozafari H, Hashemi SH, Ghotbi MH 2006 The influence of maternal ketonuria on fetal well-being tests in postterm pregnancy. Arch Iran Med 9:144-147.
  3. Metzger BE, Ravnikar V, Vileisis RA, Freinkel N 1982 "Accelerated starvation" and the skipped breakfast in late normal pregnancy. Lancet 1:588-592.
  4. Chez RA, Curcio FD, 3rd 1987 Ketonuria in normal pregnancy. Obstetrics and gynecology 69:272-274.
  5. Nitert MD, Barrett HL, Foxcroft K, Tremellen A, Wilkinson S, Lingwood B, Tobin JM, McSweeney C, O'Rourke P, McIntyre HD, Callaway LK 2013 SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women. BMC pregnancy and childbirth 13:50.