Abstract
Recent population-based studies defining the frequency of and risk factors for diabetic ketoacidosis (DKA) in pregnancy are lacking. We aimed to identify sociodemographic and clinical factors associated with DKA in pregnancy. Repeated cross-sectional study with case-control analysis of women in the National Inpatient Sample (2012-Q3 2015) with pregestational diabetes (DM) admitted to the hospital during pregnancy. The primary outcome was DKA (ICD-9 codes 250.1, 250.10, 250.12, 250.13). DKA was compared over time using a test of trend. Demographic, hospital, and clinical characteristics were compared between women with and without DKA using chi-square and student’s t-test. Multivariable logistic regression assessed what characteristics were independently associated with DKA. Variables were included in the initial model if p < 0.20 in bivariable analysis and sequentially removed using likelihood ratio testing with p < 0.05 considered significant. Of 44,159 deliveries complicated by pregestational DM, there were 1,263 cases of DKA, or 286 cases per 10,000 DM deliveries. DKA increased from 2012 to 2015 (Figure). In addition to time, factors associated with higher adjusted odds of DKA included non-Hispanic Black (vs White) race, public (vs private) insurance, urban (vs rural) hospital, larger size hospital, anemia, substance use disorder, and antenatal depression (Table). Factors associated with a lower adjusted odds of DKA included older age, Hispanic or other race (vs White), and obesity (Table). Among these, the factors with the strongest associations were obesity (aOR 0.22, 95%CI 0.18-0.28) and time (aOR 3.40, 95%CI 2.67-4.32 for 2013; aOR 3.53, 95%CI 2.78-4.48 for 2014; aOR 3.87, 95%CI 3.03-4.94 for 2015 Q1-3; referent=2012). Hypertension, renal disease and US region were not associated with DKA. In a contemporary, nationwide US sample, DKA increased over time with sociodemographic and clinical disparities. Further investigation is needed to confirm the rise in DKA after 2012 and identify how to address the identified disparities to prevent DKA in the future.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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