KETONEMIC TENDENCY IN GESTATIONAL DIABETIC PREGNANCY IN LABOR

Objective: To test whether gestational diabetic pregnancy (GDM) has ke tonemic tendencies during labor, we measured maternal plasma concentra tions of glucose, free fatty acids, acetoacetate, and 3-hydroxybutyrat e under the standard glucose infusion. Methods: Ten GDM and 11 non-GDM pregnancies of similar age, height, weight, and gestational age were recruited. After an overnight fast, food was withheld, and a 5% glucos e solution was administered at a rate of 125 ml/h. For GDM patients, i nsulin was added, if required, to obtain blood glucose levels of < 120 mg/dl. Maternal blood was sampled at 3-h intervals for 9 h. Labor was simultaneously induced by oxytocin throughout the study period. Resul ts: Oxytocin caused active labor in all patients. Both GDM and non-GDM pregnancies were euglycemic with normal concentrations of free fatty acid during the 9-h period. Concentrations of acetoacetate and 3-hydro xybutyrate gradually and significantly increased with time in GDM, whi le those remained relatively constant in non-GDM. Comparisons of the m aternal metabolic fuels between the two groups showed that ketones wer e significantly elevated in GDM after 9-h labor induction. On delivery , umbilical concentrations of glucose and ketones significantly correl ated with maternal plasma concentrations. Conclusions: GDM pregnancy h as more ketonemic tendencies than non-GDM pregnancy during labor induc tion. The results imply that relatively short-term labor induction in GDM pregnancies may induce maternal-fetal ketosis despite maternal eug lycemia.