Ketones in urine during pregnancy are often innocuous, but they can indicate a significant disease. Ketones (also called ketone bodies) are an alternative energy source for your body's cells, used when glucose is not available or can't be used. Ketones appear in the urine and blood during situations such as prolonged fasting, vomiting, and extreme exercise. Ketones in urine during pregnancy should not be ignored as they can be a sign of gestational diabetesand other disorders.
About one in five women have ketones in urine during pregnancy. The body produces more ketones during pregnancy, especially in the third trimester, because of increased energy needs . Other metabolic changes during pregnancy that promote ketone production are increased insulin resistance, accelerated fat breakdown, and more glucose production in the liver (gluconeogenesis). Ketosis is more likely among pregnant people, especially those with abnormal glucose metabolism .
High Ketones in Urine Pregnancy
The three types of ketone bodies are acetoacetate, acetone, and beta-hydroxybutyrate . They're produced in the body by breaking down fats. Most cells in your body prefer to use glucose as an energy source; ketones are an alternative energy source when glucose and other carbohydrates are not available.
Gestational diabetes is an important cause of ketones in urine during pregnancy. But ketones in urine during pregnancy are not diabetic always; they can be a sign that you're not consuming enough calories and carbohydrates. Some reasons are vomiting, fasting or long gaps between meals, and eating disorders .
Ketones are present in the blood under normal circumstances, too. The normal ketones levels are less than 0.5 millimoles/liter. Levels greater than 1.0 millimole/liter are defined as hyperketonemia, and levels more than 3.0 millimoles/liter indicate ketoacidosis .
Ketone blood levels higher than normal is called ketosis. A light state of ketosis is not a dangerous situation. However, very high levels of ketones in the blood cause it to become acidic, a dangerous condition called ketoacidosis. This happens most often with untreated or improperly treated type 1 diabetes. High concentration of ketone bodies in the bloodstream cause ketones to appear in the urine (ketonuria).
Are Ketones Harmful During Pregnancy?
Ketones in the urine don't harm your baby. However, ketonuria is a sign of high ketone levels in the blood. Ketones in the blood can cross the placenta and reach your baby.
Ketones in the urine during pregnancy have been associated with some adverse outcomes — reduced childhood intelligence quota (IQ), oligohydramnios (diminished amniotic fluid), fetal heart rate irregularities, and non-reactive non-stress tests . Birth defects like cleft lip, cleft palate, heart defects, and malformations of the digestive and nervous systems are associated with high ketone blood levels. The effects on the baby are worst in early pregnancy .
However, it is not certain that the adverse outcomes are caused by ketones. The disorder causing ketonuria may be responsible for them.
Diabetes is a frequent cause of ketones in urine during pregnancy. If not prevented, it can lead to diabetic acidosis, electrolyte imbalances, kidney failure, heart failure, and brain dysfunction .
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How To Reduce Ketones in Urine During Pregnancy
Ketones may be harmful to your baby. The American Diabetic Association (ADA) recommends efforts to maintain a normal range of ketones in urine during pregnancy . You should consume a diet with adequate calories for appropriate weight gain during pregnancy. Such a diet should contain :
Carbohydrates 175 grams
Protein 71 grams
Fiber 28 grams
Other measures to avoid ketosis and ketones in urine during pregnancy:
Meals should not be spaced very far apart, and each meal should contain some carbohydrates.
Avoid lifestyle choices such as low-carbohydrate/high-protein diet (such as the keto diet), prolonged fasting, strenuous exercise, and excessive alcohol consumption.
If you have diabetes, your doctor will advise tight control.
What Should You Do?
If you find you have ketones in your urine during pregnancy, you should take a balanced approach. Very often, it isn't dangerous and can be reversed by changes in your diet and lifestyle.
However, diabetes is a possibility when ketonuria is found. This metabolic disorder affects several organ systems and is especially severe during pregnancy. You should consult your doctor as soon as possible.
Keeping Yourself Safe From Ketosis During Pregnancy
Urine test strips are valuable during pregnancy. They help you monitor your health and detect important metabolic diseases early. Ketonox is Diagnox Health's brand of urine dipsticks to detect ketones in your urine. You can use them at home to measure the presence and concentration of urinary ketones. You can read more details about Ketonox here.
You can find other informative resources on keto diet and women's health in the following links:
K. Robinson, H. Barrett, K. Foxcroft, L. Callaway, and M. Nitert, "Prevalence of maternal urinary ketones in pregnancy in overweight and obese women," Obstetric Medicine, vol. 11, pp. 79-82, 2018. Available Online here, [Accessed on June 01, 2023].
M. Qian N. Wu, L. Li, W. Yu, H. Ouyang, X. Liu, Y. He, and A Al-Mureish, "Effect of Elevated Ketone Body on Maternal and Infant Outcome of Pregnant Women with Abnormal Glucose Metabolism During Pregnancy," Diabetes Metabolic Syndrome and Obesity, vol. 13, pp. 4581-4588, 2020. Available Online here, [Accessed June 01, 2023].
Cleveland Clinic staff, "Ketones in Urine During Pregnancy," Available Online here, [Accessed June 01, 2023].
H. Tanner, M. Nitert, L. Callaway, and H. Barrett. "Ketones in Pregnancy: Why Is It Considered Necessary to Avoid Them and What Is the Evidence Behind Their Perceived Risk?" Diabetes Care, vol .44, pp. 280-289, 2021. Available Online here, [Accessed June 01, 2023].
American Diabetes Association, "Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2018," Diabetes Care, vol. 41, pp. S137-S143, 2018. Available Online here, [Accessed June 01, 2023].
About the Author
Alaina Brandenburger has been creating content for clients since 2009. She holds an MS in Marketing from the University of Colorado Denver, and an MA in Fashion Journalism from Academy of Art University. Her areas of specialty include marketing and small business operations, health and wellness, art, and design.
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