Trends and Outcomes Among Pregnancy and Non-pregnancy Related Hospitalizations with Diabetic Ketoacidosis.

OBJECTIVE:The primary objective was to evaluate adverse outcomes among reproductive age hospitalizations with diabetic ketoacidosis (DKA), comparing those that are pregnancy related versus not 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 U.S. (2016-2020). DKA in pregnancy hospitalizations were compared to DKA in non- pregnant 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 non-pregnancy related DKA hospitalizations increased over time (APC=3.8%, 95% CI 1.5 - 6.1). After multivariable adjustment, compared to pregnancy related hospitalizations with DKA, the rates of mechanical ventilation (aRR=1.56, 95% CI=1.18-2.06), seizures (aRR=2.26, 95% CI=1.72 - 2.97), renal failure (aRR=2.26, 95% CI=2.05-2.50), coma (aRR=2.53, 95% CI=1.68-3.83) and in-hospital death (aRR=2.38, 95% CI=1.06-5.36) were higher among non-pregnancy related hospitalizations with DKA. CONCLUSION:A nationally representative sample of hospitalizations indicates that over the 5-year period, the rate of non-pregnancy related DKA hospitalizations increased among reproductive age women, and a higher risk of adverse outcomes was observed when compared to pregnancy related DKA hospitalizations.