During pregnancy, even the smallest abnormality can seem like a great cause for concern – after all, you’re responsible not only for yourself but also for another human being growing inside of you, and it’s only natural that you’d want to protect it.
Elevated ketones in the urine are one such abnormality. However, are ketones in urine while pregnant actually something to be concerned about or rather something that happens to most pregnant women? Let’s explore the topic.
- Ketones are organic compounds produced during fat break down, when the glucose present in the body is not enough to satisfy the energy needs.
- Not all ketone levels are a cause for concern. Levels up to about 0.5 millimolar are considered within normal range. Anything above that is worth consulting with a doctor, and anything above 2.9 mmol/L is considered a medical emergency.
- Symptoms of high ketone levels include constant fatigue, high blood sugar levels, constant thirst and frequent vaginal and bladder infections.
- There are several reasons one might have high ketone levels, including frequent vomiting, dehydration, infections or other health conditions and undiagnosed or improperly managed diabetes.
- The easiest way to check if your ketone levels are high is through urine testing.
- Unaddressed high ketone levels due to diabetes can potentially lead to diabetic ketoacidosis, which might have dangerous effects on both the mother and the baby. The condition is treatable.
- Treating high ketone levels typically involves lifestyle and diet changes. When the cause for it is diabetes, medication might also be involved.
- Attending regular prenatal checkups is crucial in ensuring your and your baby’s health.
What Are Ketones?
When you consume food, you provide your body with a number of nutrients, one of which are carbohydrates. Carbohydrates are then broken down into glucose, which is used to fuel your body – it’s thanks to them that have energy. However, sometimes, your body might either not receive enough carbohydrates or is unable to absorb the glucose properly.
When that happens, your body reaches for plan B, using fat as an alternative source of energy. In the process, however, it also creates ketones, which are produced by the liver and then excreted by your kidneys into the urine.
Now, let’s get one thing straight – ketones are usually present in your urine anyway. However, it’s how many of them there are that’s important. Generally, a ketone level of about 0.5 millimolar is considered to be within the normal range of ketones in urine during pregnancy. Levels between 0.5 mmol/L to 1.5 mmol/L are considered low to moderate, 1.6 to 2.9 mmol/L are high, while anything above is considered a medical emergency.
High levels of ketone in urine are also known as ketonuria. According to studies, the condition affects at least one in five pregnant women. It usually occurs in the middle of your pregnancy, in the 16 to 28 weeks range.
High Ketones in Urine During Pregnancy – Symptoms
Some of the common symptoms indicating your ketone levels might be higher than normal include:
- High blood sugar levels
- Continuous thirst despite drinking a lot
- Fatigue and being overly tired
- Frequent bladder or vaginal infections
What Can Increase Ketone in Urine During Pregnancy?
There are a number of reasons for elevated ketone levels. Some of those are:
- Frequent vomiting – Pregnancy often comes with morning sickness, which, despite the name, can catch you at any time of day. If you find yourself constantly throwing up, then chances are high that your ketone levels will be higher than normal. This is because vomiting is frequently accompanied by nausea, and when that happens, the last thing you think about is eating. This leads to insufficient nutrients being delivered to your body, resulting in it not having enough glucose and energy to use, so it has to use stored fats instead, which leads to ketone formation.
- Dehydration – When your body is dehydrated, it is unable to eliminate waste products effectively. It can be caused by a number of reasons, from not getting enough fluids to not getting enough rest.
- Infections and other health conditions – Being sick with high fever and decreased appetite can also result in higher ketone levels.
- Undiagnosed or improperly managed diabetes – A large number of people with diabetes don’t even know that they have it. Hormonal changes associated with pregnancy can worsen the insulin deficiency. Being unable to process the sugars it needs, your body reaches for the alternative – stored fats, using them as fuel. Increased ketone levels are common among those mothers who do not take their insulin shots as they should or use expired insulin.
When pregnant, you can develop something called gestational diabetes mellitus (GDM for short), which differs from type 1 and type 2 diabetes. It only occurs during pregnancy, so it’s very likely that even if you had it, after delivery your blood sugar levels will go back to normal.
So, how does it differ from other types of diabetes? Type 1 and type 2 diabetes are characterized by lack of insulin due to the pancreas producing less than needed or the body’s inability to absorb it correctly. In GMD, however, it’s not the insulin’s fault per se, but rather it’s the other hormones that are released during pregnancy that make it less effective.
There are also other possible causes for increased ketone levels, including low carbohydrates diet or certain digestive diseases.
How Do You Check for Ketones in Urine?
The easiest way to determine whether your ketone levels are within a normal range or elevated is through a urine test, which is already a standard for each trimester.
If you want to monitor your ketone levels at home, to ensure that they won’t reach a certain range, you can buy dipstick tests – they use a plastic strip that changes color if the level of ketones in your urine fall within a specific range. However, keep in mind that those tests won’t tell you the exact measurement – just a more general idea.
What are the best times to test for ketones? Ideally, you should do it in the morning, before eating any meal or drinking water, and, if done more than once, at the same time each day. Testing could also be beneficial when you’re experiencing symptoms associated with high ketone levels.
Here is why:
- Morning – By doing the test in the morning, the doctors have an indication of how your ketone levels look overnight.
- Before a meal – Testing when you’re in a fasting state (you haven’t eaten yet), gives healthcare professionals a clearer picture of how your ketone production and utilization are.
- The same time – Performing tests consistently at the time each day allows your doctor to sooner notice abnormalities in the levels and increases accuracy.
- Symptomatic periods – Performing a ketone test when experiencing symptoms can help the doctor figure out if the ketone levels are the reason, or there are other things that are causing you to experience them, not ketones.
Can Ketones in Urine Be Dangerous for the Baby?
As mentioned, some levels of ketones are completely normal and are not a cause for concern. Depending on what caused the elevated levels in the first place, managing them and bringing them back within a normal range is not difficult.
The issue arises when the high levels are a result of undiagnosed or unmanaged diabetes, as it can lead to the development of a condition called diabetic ketoacidosis, which, if left undiagnosed and untreated, can potentially be life-threatening to both the mother and the fetus.
Diabetic Ketoacidosis – Symptoms
Diabetic ketoacidosis, or DKA for short, can initially be hard to diagnose in pregnant women as some symptoms can be mistaken as normal signs of pregnancy, such as nausea or vomiting.
However, there are other symptoms that someone with DKA can present with, and they all depend on how advanced the condition is.
Common symptoms present in most cases include:
- Nausea
- Vomiting
- Abdominal pain
- General fatigue
- Polyuria
- Polydipsia secondary to hyperglycemia
- Volume depletion symptoms, including dry mucous membranes, increased skin turgor, tachycardia, and hypotension.
Severe cases might present with:
- Rapid, shallow breathing
- Fruity breath
- Altered mental state
- Lethargy
- Disorientation
Rarely, patients with diabetic ketoacidosis might develop cerebral oedema, which, put simply, is swelling of the brain.
As for the fetus, according to a study, ketones can get into your baby’s central nervous system, untreated DKA can lead to increased fetal mortality. As A study of diabetic ketoacidosis in the pregnant population in the United Kingdom: Investigating the incidence, etiology, management and outcomes uncovered, among the 82 women who were part of the research and who were diagnosed with DKA, 12 fetuses died, with 11 stillbirths and one neonatal death.
Additionally, DKA during pregnancy can lead to a number of both short term and long term fetal complications, including decreased uterine perfusion, fetal hypoxia and frequent late decelerations. Other ways ketones can affect the fetus include growth abnormalities, internal organs distortion, lateral brain ventricles reduction or reduced volume.
All in all, it’s important that high ketone levels are treated as soon as they are discovered to prevent any long term effects on both the mother and the baby.
How to Treat DKA in Pregnant Women
Although dangerous, diabetic ketoacidosis is treatable, and the management of the condition is similar in those who are and aren’t pregnant. The key components of the treatment plan include insulin infusion, volume replacement, serum potassium correction and fetal monitoring. The patient will be administered IV fluids and electrolyte replacement.
Ketosis vs Ketoacidosis
Ketosis and ketoacidosis can sometimes be confused, but they are two completely different things. Ketosis is simply the process of breaking down fat during which ketones are produced, while ketoacidosis is a potentially life-threatening condition occurring in pregnant women with diabetes (but not only).
How to Reduce Ketones in Urine During Pregnancy
In many cases, the ketone levels will go back to normal through a diet and lifestyle change. If you have diabetes, regularly taking your insulin shots and monitoring blood glucose levels is crucial in it. It’s important to organize regular prenatal checkups, so that the doctor can monitor both yours and your baby’s health. Being on top of your appointments can help medical professionals diagnose issues before they become significant.
Some things that can help you ensure it doesn’t happen again include:
- Not skipping meals
- Having snacks in between meals
- Eating at least three meals and three snacks a day
- Making sure you are well-hydrated at all times (it is recommended that during pregnancy you drink between 8 to 12 glasses of water daily)
- Not cutting down on carbs during pregnancy
- Adding protein-rich foods to the diet (e.g. eggs, beans, meat and tofu)
- Keeping your diet carbohydrates-rich by including foods like rice, pasta, oats and whole grain bread
- Regular exercise staying active (to prevent gestational diabetes)
Remember – when you’re pregnant, you need to increase your food intake compared to what you ate before pregnancy, as you’re no longer feeding only yourself – instead, it is being distributed between two people, so it’s only natural that you’d require more to satisfy your dietary needs.
The Bottom Line
While seeing an increased ketone level on your test results might seem concerning at first, in most cases it is not a cause for concern and can be easily adjusted through lifestyle and diet changes. The exception is when the reason why it happened in the first place is diabetes, whether that be diabetes type 1 or type 2 or GDM. In this case, insulin shots or medication might be needed, although the final decision about the course of treatment will be taken by your doctor.
Pregnancy can be a scary time, but it doesn’t have to be. We live in an era with advanced medicine, and most things that could be concerning can be diagnosed before they become more dangerous or have a significant impact on either you or the baby. However, it’s still important that you take extremely well care of yourself during this time. It’s a team effort, you could say.
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