Blood Ketone Test Tops Urine Test in Gestational Diabetes

TOPLINE:Testing blood ketone levels before breakfast, lunch, and dinner identified a greater number of ketosis episodes than testing urinary ketone levels in women with gestational diabetes (GD). The presence of fasting blood ketones was strongly correlated with the presence of ketones before lunch and dinner, indicating the necessity for more comprehensive monitoring.

METHODOLOGY:Women diagnosed with GD are asked to check their ketone levels by testing their urine before breakfast; however, since ketosis can develop at any time throughout the day, utilising blood ketone measurements may offer a more precise evaluation of the condition.Researchers in Italy conducted a prospective study to evaluate the effectiveness of intensive blood ketone measurements in detecting ketosis among 101 women (mean age, 34.7 years) who were diagnosed with GD between gestational weeks 24 and 28 and tested negative for urinary ketones.Participants underwent blood ketone measurements before their main meals during gestational weeks 30-32; ketonaemia was defined as having fasting blood ketone levels > 0.1 mmol/L for at least 25% of the time and > 0.2 mmol/L before lunch and dinner.They received a diet plan of 1800 kcal/d that was distributed across three main meals and three snacks, with the following caloric distribution: Breakfast, 10%-15%; lunch, 20%-30%; dinner, 30%-40%; and three snacks, 5%-10%.The primary outcome of the study was the detection rate of blood ketosis episodes before breakfast, lunch, and dinner.TAKEAWAY:Blood ketones were detected in 37.6% of participants before breakfast, 13.9% of participants before lunch, and 11.9% of participants before dinner, with 40.6% of women showing at least one daily presence of blood ketones.The presence of fasting blood ketones was significantly correlated with the presence of ketones before lunch (correlation coefficient [r], 0.63; P < .0001), before dinner (r, 0.55; P < .0001), and with 1-hour post-breakfast mean glucose levels (r, 0.23; P = .02).A subgroup analysis showed no significant differences in blood ketone positivity across pre-pregnancy body mass index categories and between women treated with diet alone vs diet plus insulin, those younger than 35 years vs those aged 35 years or older, and those with vs without a family history of type 2 diabetes.IN PRACTICE:"Intensive blood ketone measurement should be recommended to women with GDM [GD mellitus] in order to better manage pregnancies complicated by the disorder and to limit the potential adverse effects of ketosis," the authors wrote. SOURCE:This study was led by Basilio Pintaudi, Niguarda Cà Granda Hospital, Diabetology, Milan, Italy. It was published online on April 29, 2025, in Hormones. LIMITATIONS:This study did not analyse correlations between ketone levels and neonatal outcomes. The effect of the presence of ketones on the neuropsychological development of children could not be evaluated because of the short follow-up period. DISCLOSURES:This study did not receive any funding. The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.