Ketones In Urine During Pregnancy – What are the Effects On The Baby?

What Are Ketones?

Ketones, according to our chemistry lessons are simple compounds containing a Carbonyl Group. They are acidic in nature. These are also involved in a lot of organic reactions. Sugar ketones are collectively called Ketoses. Ketone bodies are water soluble and are produced by the liver due to excessive break down of fatty acids. These ketone bodies are transported to other tissues where they are converted to acetyl coenzyme A for production of energy.

This Acetyl CoA is used by in the mitochondria of our body cells to produce energy. Ketone bodies are produced from acetyl coenzyme A. Normally, ketone bodies are found in extremely trace amounts as they are an energy source for our vital organs (except liver) and muscles of the body.

It is important to understand that ketones are produced in the body only when glucose is not available as an energy source. In case of starvation, about 75% of energy for the brain is derived from ketone bodies.

Ketones are Formed Inside The Body in The Following Conditions

1. Uncontrolled Diabetes Mellitus
2. Trauma, Injury and Severe illness
3. Prolonged Exercise and Rapid Weight Loss
4. Dehydration from excessive vomiting or diarrhea
5. Ether Anesthesia
6. Alcoholism
7. Fasting and starving
8. Low carbohydrate diet
9. Metabolism of synthetic triglycerides
10. Deficiency of insulin
11. Glycogen storage disease
12. Hyperthyroidism
13. Pregnancy

Excess accumulation of ketones is called “Ketosis”. Since ketones are acidic in nature, excessive production of ketones causes a fall in blood pH due to the release of H^+ ions into the blood. This condition is called “Keto-Acidosis”.

Ketone Bodies are Found in The Following Three Forms:

1. Aceto Acetate
2. Beta Hydroxybutyrate
3. Acetone

Acetone levels are much lower than the other two forms and it is normally not used by the body as an energy source. It also cannot be converted back to acetyl coenzyme A and therefore it is excreted in urine. In patients with keto-acidosis, “fruity” or sweet odour of patient’s breath is due to acetone.

Normal Ranges for Ketones in The Body

In plasma – 0.2mmol/L
In urine – less than 3mg/day

What are Urinary Ketones?

In case of fasting and starvation (when glucose is unavailable) and diabetes mellitus (when glucose is excess and all of it cannot be utilized), aceto-acetate and beta-hydroxybutyrate become a source of energy. When ketones are produced excessively, they are excreted in urine.

Ketones are not found in the urine of relatively healthy individuals. Excretion of ketones in urine is called “Ketonuria”. Presence of ketones in urine means that your body is using up more fats than carbohydrates to generate energy. For diabetic individuals, testing for urine ketones gives an estimate of blood sugar level control.

Levels of Urine Ketones and What Do They Mean

Normal – Up to 0.6 mmol/L
Trace – 0.6-1.5 mmol/L
High – 1.6-3.0 mmol/L
Dangerous – More than 3.0 mmol/L

What Causes Presence of Ketones in Urine During Pregnancy?

Presence of urine ketones during pregnancy indicates a severe health problem. Although there may be no symptoms in the beginning, urine ketones during pregnancy is an alarming condition. During pregnancy, a woman’s body undergoes a lot of hormonal and physical changes.

Following Causes could be Responsible for Finding Urine Ketones During Pregnancy:

1. A low carbohydrate diet
2. Hyperemesis – Excessive vomiting during pregnancy
3. Prolonged time between meals
4. Irregular meal timing
5. Skipping meals
6. Overweight and obesity
7. Fasting during pregnancy
8. Gestational Diabetes Mellitus
9. Insulin Resistance
10. Eclampsia is often associated with ketonuria

In case of excessive nausea and vomiting, your clinician may check for the presence of urine ketones. Presence of urine ketones along with high blood sugar levels during pregnancy may indicate a possibility of gestational diabetes. Urine ketones can be easily measured by using a dip-stick method on a clean-catch midstream urine sample.

Ketones in Urine During Pregnancy Effects on Baby

Presence of abnormal levels of urine ketones during pregnancy can have deleterious effects upon the baby. This is because ketones have known to cause alteration

1. Amniotic Fluid Volume
2. Amniotic Fluid Composition
3. Fetal Heart Rate

Additional Conditions that can occur due to Urine Ketones During Pregnancy are

1. Pre-term birth
2. Low blood sugar levels at birth
3. Jaundice at birth
4. Intra-uterine growth retardation
5. Increase in birth weight as compared to normal deliveries
6. Still birth – the death of a child at birth
7. The child after being born has a higher risk of being obese or diabetic at later life

How to Get Rid of Urinary Ketones During Pregnancy?

It is always advisable to consult your clinician. Once detected, urine ketones need to be checked at regular intervals.
As we know that prevention is better than cure, even though you may find urine ketones during pregnancy, certain measures can be taken to bring those to normal and prevent further increase in

Urinary Ketones:

1. Avoid skipping meals and avoid keeping long gaps between two meals.
2. Eat after every 3-4 hours during pregnancy.
3. Before sleeping, have a meal rich in proteins and starch. Starch and proteins in diet provide energy to the body for a longer duration.
4. Maintain good hydration. Drink lots of fluids to avoid dehydration.
5. Maintain a food diary to keep track of what you are eating and how many calories.
6. Consult your physician about managing blood sugar levels.
7. Prefer food having a low glycemic index – kale, eggplant, cucumber, cauliflower and peaches.
8. Cinnamon is a well known home remedy which promotes absorption of glucose even in absence of insulin.

Foods to Avoid

1. Fruit juices and sugary drinks
2. Starch containing foods like potatoes
3. Processed and whole grains
4. Fruits
5. Candies and bakery products
6. Beans and legumes
7. Refined sugars

During pregnancy, it is important for females to have a balanced diet along with some sort of routine exercise at all times.

For pregnant women with diabetes, managing blood sugar levels and having a well-balanced diabetic diet is essential to prevent the formation of urine ketones during pregnancy. Urine ketones and blood sugar levels need to be monitored regularly.