Trends and Outcomes among Pregnancy and Nonpregnancy-Related Hospitalizations with Diabetic Ketoacidosis

Objective The study’s primary objective was to evaluate adverse outcomes among reproductive-age hospitalizations with diabetic ketoacidosis (DKA), comparing those that are pregnancy-related versus nonpregnancy-related and evaluating temporal trends. Study Design We conducted a retrospective cross-sectional study using the National Inpatient Sample to identify hospitalizations with DKA among reproductive-age women (15–49 years) in the United States (2016–2020). DKA in pregnancy hospitalizations was compared with DKA in nonpregnant hospitalizations. Adverse outcomes evaluated included mechanical ventilation, coma, seizures, renal failure, prolonged hospital stay, and in-hospital death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risk (aRR) and 95% confidence interval (CI). Annual percent change (APC) was used to calculate the change in DKA rate over time. Results Among 35,210,711 hospitalizations of reproductive-age women, 447,600 (1.2%) were hospitalized with DKA, and among them, 13,390 (3%) hospitalizations were pregnancy-related. The rate of nonpregnancy-related DKA hospitalizations increased over time (APC ¼ 3.8%, 95% CI ¼ 1.5–6.1). After multivariable adjustment, compared with pregnancy-related hospitalizations with DKA, the rates of mechanical ventilation (aRR ¼ 1.56, 95% CI ¼ 1.18–2.06), seizures (aRR ¼ 2.26, 95% CI ¼ 1.72–2.97), renal failure (aRR ¼ 2.26, 95% CI ¼ 2.05–2.50), coma (aRR ¼ 2.53, 95% CI ¼ 1.68–3.83), and in-hospital death (aRR ¼ 2.38, 95% CI ¼ 1.06–5.36) were higher among nonpregnancy-related hospitalizations with DKA.