Monitoring blood and urine ketones in gestational diabetes mellitus

Includes bibliographical references.Gestational Diabetes Mellitus (GDM) is diagnosed in 3-5% of all pregnancies. It is defined as carbohydrate intolerance that develops or is first identified during pregnancy. Typically, gestational diabetics have normal carbohydrate tolerance before and after pregnancy. If GDM remains untreated, both the mother and the fetus are at increased risk for complications. These complications include cesarian delivery, macrosomia, hypoglycemia, polycythemia, and hyperbilirubinemia. Ketone testing is one way to help control the effects of GDM. A high level of ketones indicates inadequate maternal carbohydrate and/or energy intake. Studies have shown that high maternal blood ketones are associated with lower IQ in offspring. Presently, many women test their urine for ketones. However, because only 25% of ketones are excreted in the urine, blood ketones may be a better indicator of ketone status. Blood and urine ketones were recorded twice daily for 10 days from 12 subjects. The results showed that over half the time that blood ketones were high, the urine ketones were low. It would appear then, that blood ketone testing more accurately detects maternal ketone status. Because most women with GDM perform SBGM and are obtaining blood samples, it would be beneficial to also perform blood ketone testing at the same time.M.S. (Master of Science