THU304 Diabetic Ketoacidosis In Pregnancy: A Nationwide Analysis Of Trend In Hospitalizations, Comorbidities And Outcomes

Abstract

Abstract Disclosure: V. Master: None. M. Faisaluddin: None. S. Fatima: None. D. Parekh: None. S. Charatz: None. Introduction: Diabetic Ketoacidosis (DKA) is an obstetric emergency associated with high materno-fetal morbidity and mortality. Aim: To analyse the trend of DKA hospitalizations among pregnant women, and to evaluate the comorbidities and in hospital outcomes associated with DKA events in United States. Methods: A national population- based study was conducted in the US. Hospitalizations during pregnancy from 2015 - 2020 were identified using ICD- 10 codes (E101) from Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS) database. Pregnant women with DKA and without DKA formed the two comparison cohorts. Demographic characteristics, baseline comorbidities, and outcomes such as maternal mortality, fetal mortality, length of stay (LOS), and cost of hospitalization were compared. A two- tailed p-value of p< 0.05 was used to determine the statistical significance. Results: 11,215 out of 14,613,248 hospitalizations during pregnancy were identified with DKA from 2015 - 2020. An increasing trend in DKA hospitalizations per 100,000 pregnancy related hospitalizations was noted, highest in 2017 and 2020. Demographic distribution was similar in both groups. Comorbidities such as pre-eclampsia, eclampsia, gestational hypertension, tobacco and alcohol use were more common in the DKA group (p<0.0001). DKA was associated with higher maternal (0.18% vs 0.01%) and fetal mortality rates (2.9% vs 0.7%) compared to non-DKA group (p<0.0001). The median length of hospital stay was higher (3 days vs 2 days), along with the median cost of hospitalization ($25,248 vs $18,306) among pregnant DKA patients. Other in hospital outcomes such as need for mechanical ventilation, cardiac arrest, cardiac arrhythmias, acute kidney injury, need for dialysis, and septic shock, were all higher in DKA patients (p<0.0001). Conclusion: DKA in pregnancy is associated with high maternal and fetal mortality, longer LOS, higher cost of hospitalizations, and other maternal morbidities, as compared to non-DKA hospitalizations during pregnancy. A high index of suspicion for DKA should be maintained in all pregnant women, along with prompt evaluation and treatment. Presentation: Thursday, June 15, 2023