To compare intrapartum results associated with differing degrees of
ketonuria in nulliparous women with
gestational diabetes mellitus (GDM), we implemented a retrospective cohort study comparing clinical characteristics among differing degrees of
ketonuria and the duration and distribution of
ketonuria at different stages of labor. We also analyzed adverse maternal and neonatal outcomes for each group. A total of 570 GDM deliveries were included; of these, 238 had negative
ketonuria (41.8%), 180 had moderate
ketonuria (31.6%), and 152 had
ketosis (26.6%). The proportion of patients with a family history of diabetes significantly increased as the degree of
ketonuria increased (P < 0.001). Moreover, a significantly lower level of HOMA-IR (the
insulin resistance index) was observed for the Negative group (P < 0.001). The
triglyceride (TG) level was significantly higher in the
Ketosis group (P < 0.001), and the total
cholesterol (TC) levels significantly increased as the degree of
ketonuria progressed (P < 0.001). There were also higher maternal
blood sugar levels and a significantly higher proportion of
oxytocin augmentation in
ketonuria cases (P < 0.001). Over three-fourths of patients (75.6%) had a
ketonuria duration of ≤2 hours in the Moderate group, 61.2% had a
ketonuria duration of between 3 and 4 h in the
Ketosis group, and most of the
ketonuria cases resolved in the first stage of labor. As the degree of
ketonuria progressed, we observed a significantly higher number of cases with fetal heart rate pattern III (FHR pattern III), meconium-stained amniotic fluid III (MSAF III), postpartum
hemorrhages, prolonged labor, neonatal
hypoglycemia, an umbilical cord arterial pH of <7.2, low Apgar scores, increased
neonatal intensive care admissions, augmented
forceps-assisted deliveries, and conversions to
cesarean sections. The results showed that
ketonuria is common during the intrapartum period and that the risk of adverse maternal and neonatal outcomes may increase when complicated with
ketonuria.