Ketones are produced when the human body uses fat reserves instead of glucose to produce the necessary energy to function, a metabolic state known as ketosis. But why may you find ketones in urine during pregnancy?
The presence of ketones in the urine is termed ketonuria (1). The hormonal changes of pregnancy may affect the body’s resistance to insulin, affecting glucose metabolism (2). This change prevents the cells from using the glucose in blood sugar to produce energy. Instead, it leads to the cells using stored fat to produce energy, resulting in ketone production.
Read this post as we explain the causes, treatment, prevention, and implications of ketonuria during pregnancy.
Why Do Ketones Occur In Urine During Pregnancy?
Ketones may develop in the urine due to various reasons. Although ketones appear in trace amounts throughout the pregnancy, excess ketones in urine for a considerable time could be an indication of gestational diabetesiXThe inability of the body to produce sufficient insulin during pregnancy . If diagnosed early, the condition can be managed to ensure that you and your baby are both healthy.
Are Ketones In Urine Normal During Pregnancy?
Studies suggest that ketonuria is a common finding during pregnancy, possibly due to fasting or starvation, or vomiting over a long period (3). It is also reported that the appearance of ketones in urine was found throughout the pregnancy. So, if you find traces of ketones on and off during pregnancy, then it might not be linked to gestational diabetes.
However, this study also states that gestational diabetes is a possibility for a woman who showed clinical indications of pre-diabetes, or is showing signs of gestational diabetes. (1).
Your doctor is the best person to understand and interpret whether the ketones in your urine indicate an adverse maternal condition, such as poor renal function, because, if the level of ketones goes up, it may lead to diabetic ketoacidosis (DKA), a complication in diabetic pregnancies that can cause fetal loss (3), (4).
Ketones can develop in the urine due to many reasons. Find out what they are next.
What Causes Ketones In Urine During Pregnancy?
During pregnancy, ketones can develop in urine if you (5):
- Did not eat properly on the previous day
- Missed your bedtime snack
- Are on a low-carbohydrate diet
- Are fasting during pregnancy
- Have extreme morning sickness and diarrhea that leaves you dehydrated
- Have any illness or infection
- Did strenuous exercise on the previous day
- Have gestational diabetes
It is important to know if the ketones in the urine pose any harm to the fetus. The section below talks about it.
Can Ketones Harm Your Baby?
Yes, they can, but only when your test results show abnormal ranges consistently. Studies show that ketones can easily cross the placentaiXA temporary organ formed near the uterine wall during pregnancy to provide nutrients and oxygen to the fetus and affect the fetal central nervous system. It showed embryo growth abnormalities, reduced volume, and distortion of the internal organs.
The studies have also shown a reduction of the cerebral cortex volume, corpus callosumiXA group of nerve fibers that act as a medium of connection for the left and right hemispheres of the brain , hippocampusiXA brain structure within the temporal lobe associated with learning and memory functions , larynxiXA muscular organ situated between the nose and the lungs that manages voice and sound , lateral brain ventricles, and thymusiXLocated behind the breastbone, it is a gland that supports the T cells, which are crucial for the immune system . However, the studies on the influence that ketones have on fetal development are limited (5).
In any case, you can test for ketones in urine at home and track the ketone level on an everyday basis.
Lab Test To Detect Ketones In Urine During Pregnancy
As high levels of ketones in urine might indicate an underlying clinical cause, you doctor might recommend a clinical diagnosis if they notice some of the below symptoms.
- High blood glucose levels
- Unusual thirst
- Frequent vaginal, and bladder infections.
Lab tests for ketones in urine include urine-based dipstick test and blood tests (6).
How To Test For Ketones In Urine At Home?
You can also monitor the ketones in your urine using the dipstick test available at various pharmacies. Use it on the first urine of the day for the most accurate result. Ideally, the reading should be negative to trace (5).
You can take the test at home using the kit. First, take the urine sample in a clean container and dip the strip into the sample. Take it out and leave it aside for a few minutes. When the color of the strip pad changes, compare it to the color chart mentioned on the kit bottle (5). If the ketone level in the urine is moderate or large, then, seek your doctor’s advice.
The ketone urine test is used to detect an already existing condition of ketonuria. Your doctor might prescribe blood monitoring to determine if you are having gestational diabetes. If your doctor finds out that you have gestational diabetes, then they would recommend diet and lifestyle changes to keep the blood glucose levels normal throughout the pregnancy.
The section below throws light on some preventive measures to control the ketone levels in urine during pregnancy.
How To Treat Ketonuria?
Based on the test results of the diagnostic tests, your doctor might prescribe the following treatment options.
- If you are showing trace amounts of ketones and if they are due to vomiting or changes in diet, then it would resolve on its own.
- But if your blood glucose levels indicate gestational diabetes, then your doctor might prescribe insulin, or dietary changes.
- If the ketonuria is due to infection, then your doctor might prescribe medications, which are safe during pregnancy, to treat the infections.
How Can You Prevent Ketones In Urine?
Here are a few simple steps to keep your ketones at a healthy level (5):
- Never skip meals
- Eat three snacks and three meals every day
- Include protein in your diet
- Do not cut down on carbohydrates during pregnancy
- exercise and stay active to reduce the risk of gestational diabetes
Frequently Asked Questions
1. What is the normal range of ketones in urine during pregnancy?
If the concentration of ketone bodies is less than 0.5 mm (millimolar), it is considered to be a normal level during pregnancy. An excess level may arise due to different factors such as exercising for too long, improper diet, or a ketogenic diet (7).
2. Why do I have ketones in my urine if I am not diabetic?
Diabetes is one of the risk factors for ketones in the urine. Even non-diabetic people may develop ketones in urine if their body utilizes fats instead of glucose to keep functioning. Other reasons for non-diabetic people to have ketones in urine can be chronic vomiting, extreme workouts, eating disorders, or a low-carb diet (8).
3. Can not eating cause ketones in urine?
Yes. Starving or not eating for long durations is believed to be one of the causes of ketones in the urine.
4. What infections cause ketones in urine?
Although ketones are present in minute amounts during pregnancy, excessive ketones in urine during pregnancy over an extended period could indicate gestational diabetes. While ketones in trace amounts can be corrected with diet and lifestyle changes, higher ketone levels in the urine necessitate immediate medical treatment. Early treatment will also reduce yours and your baby’s chances of experiencing any pregnancy issues. Avoiding skipping meals, having frequent meals in intervals and protein-rich foods, exercising, and being physically active could also help to prevent excess ketones when pregnant.
Infographic: More About Diabetic Ketoacidosis
Diabetic ketogenesis in pregnancy (DKP) is a serious condition and may be life-threatening if left untreated. Physiological changes during pregnancy may predispose some women with gestational diabetes to DKP. The infographic below tells you more about its symptoms and management protocols.
Illustration: MomJunction Design Team
- Ketones in the urine can be detected throughout the pregnancy.
- Gestational diabetes, a low-carb diet, or fasting may cause ketones in urine during pregnancy.
- A urine-based dipstick test and some blood tests can identify a high ketone level in a pregnant woman’s urine.
- The treatment for ketonuria during pregnancy varies depending on the cause.
- If you have trace quantities of ketones in your system, a slight change in your diet and lifestyle can help.
2. Symptoms & Causes of Gestational Diabetes; National Institute of Diabetes and Digestive and Kidney Diseases
3. Ketones in Urine; Medline Plus; US National Library of Medicine
4. Learning about ketones; Allina Health’s Patient Education Department (2014)
5. Agata Bronisz, et al.; Pregnancy Ketonemia and Development of the Fetal Central Nervous System; NCBI (2018)
6. Alice. A. Gibson et al.; (2020); Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet; Wiley Online Library
7. Meichen Qian et al.; Effect of Elevated Ketone Body on Maternal and Infant Outcome of Pregnant Women with Abnormal Glucose Metabolism During Pregnancy; Diabetes Metab Syndr Obes
8. Ketone bodies (urine); University of Rochester Medical Center
9. Ketones urine test; The Regents of The University of California.
10. Ketones in Urine During Pregnancy; Cleveland Clinic
11. Diabetes-Related Ketoacidosis (DKA); Cleveland Clinic
12. Juyi Li et al.; (2020); COVID‐19 infection may cause ketosis and ketoacidosis.