Ketones in Pregnancy: Why Is It Considered Necessary to Avoid Them and What Is the Evidence Behind Their Perceived Risk?

Helen L Tanner, Marloes Dekker Nitert, Leonie K Callaway, Helen L Barrett

Journal: Diabetes care 2021;44(1):280-289

PMID: 33444162

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Abstract

Current dietary advice for women with gestational diabetes mellitus is to avoid diets that result in elevated ketone levels. This guidance stems from a concern that maternal ketones are associated with poor fetal and childhood outcomes, including reduced childhood intelligence quota. The evidence behind these guidelines is conflicting and inconsistent. Given that dietary counseling is the initial treatment strategy for women with diabetes in pregnancy, it is important that clinicians understand the concern regarding maternal ketones. This review examines the physiology of ketogenesis in pregnancy, the prevalence of elevated maternal ketone levels, and the relationship between maternal ketones and fetal and childhood outcomes.

Address: School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia [email protected].; School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, St. Lucia, Queensland, Australia.; Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.; Mater Research Institute, The University of Queensland, and Mater Hospital Brisbane, South Brisbane, Queensland, Australia.

DOI: 10.2337/dc20-2008

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MeSH Terms: Child, Diabetes, Gestational, Diet, Female, Humans, Ketones, Pregnancy, Prenatal Care