Ketones In Urine During Pregnancy: Causes And Prevention

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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.

In This Article

Key Pointers

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.

Why Do Ketones Occur In Urine During Pregnancy?

Excess ketones in urine could indicate gestational diabetes

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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 diabetesⁱThe 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 meals or bedtime snack
Are on a low-carbohydrate diet

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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

Gretchen Fleener, a mom of two, learned about ketones when she was diagnosed with gestational diabetes during her second pregnancy. Recollecting her journey, she says, “I already guessed that having too much sugar would send too much to the baby, making the baby gain weight. ” I didn’t realize that having too FEW carbs would also send “ketones” to the baby.

“I was not supposed to cut out ALL sugar… I just had to have a specific amount of grams at specific times of the day. It is why you have to make sure to have snacks every two to three hours throughout the day between meals to prevent your body from sending ketones to the baby (i).”

Quick fact

Hyperthyroidism can also lead to increased ketones in the urine (9).

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 placentaⁱA 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 callosumⁱA group of nerve fibers that act as a medium of connection for the left and right hemispheres of the brain , hippocampusⁱA brain structure within the temporal lobe associated with learning and memory functions , larynxⁱA muscular organ situated between the nose and the lungs that manages voice and sound , lateral brain ventricles, and thymusⁱLocated 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, your doctor might recommend a clinical diagnosis if they notice some of the below symptoms.

High blood glucose levels
Unusual thirst

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Fatigue
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?

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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 some dietary changes or insulin during pregnancy.
If the ketonuria is due to infection, then your doctor might prescribe medications, which are safe during pregnancy, to treat the infections.

Monitoring ketone levels and consulting your healthcare provider regularly is essential to help prevent complications.

Caution

Call your healthcare provider if you have a history of ketones and notice symptoms such as fever, vomiting, diarrhea, an unexplained increase in blood sugar levels, and a sudden increase in ketones in your urine (10).

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

Health fact

Increasing the amount of water consumption can prevent ketones in urine during pregnancy (10).

Exercise to reduce the risk of gestational diabetes

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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?

Infections such as urinary tract infection (UTI), pneumonia, COVID-19, and some skin infections, may lead to the presence of ketones in urine, especially in diabetes-related ketoacidosis (11) (12).

5. Can dehydration cause ketones in urine?

Dr. Ila Dayananda, board-certified obstetrician/gynecologist from Brooklyn, New York, says, “The liver produces ketones during energy production as fat is burned for energy fuel. Dehydration can increase ketones in urine when the body doesn’t have enough fluid to dilute and excrete them as waste. A dehydrated body will try to compensate by breaking down fat stores for energy, which increases ketones.”

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.

diabetic ketoacidosis in pregnancy (infographic)

Illustration: MomJunction Design Team

Personal Experience: Source

MomJunction articles include first-hand experiences to provide you with better insights through real-life narratives. Here are the sources of personal accounts referenced in this article.

i. How I coped with gestational diabetes…over thanksgiving & Christmas!https://www.idmommy.com/2010/11/how-i-coped-with-gestational.html?m=0

References

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.

1. Helen L Robinson, et al.; Prevalence of maternal urinary ketones in pregnancy in overweight and obese women; The Royal Society of Medicine Journals
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.

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Reviewer Expert Author Editor Fact Checker

Dr. Karishma BhatiaMS

Dr. Karishma Bhatia did her MS in Obstetrics and Gynaecology from Maulana Azad Medical College (MAMC) and currently practices in Rohini, North Delhi. She also completed DNB, MNAMS and Fellowship training in Gynaecological Laparoscopy (Kiel, Germany) and Reproductive Medicine.

Read full bio of Dr. Karishma Bhatia

Dr. Ila DayanandaMD, MPH Dr. Ila Dayananda, a board-certified obstetrician & gynecologist, most recently served as the chief medical officer for Planned Parenthood of Greater New York. She studied medicine and master's in Public Health at Northwestern University Medical School and then pursued an OB/GYN residency at the Beth Israel Deaconess Medical Center in Boston, MA. Dr. Dayananda holds a Family Planning Fellowship at Brigham and Women's Hospital/Harvard Medical School in Boston, MA.
Dr. Ila Dayananda, a board-certified obstetrician & gynecologist, most recently served as the chief medical officer for Planned Parenthood of Greater New York. She studied medicine and master's in Public Health at Northwestern University Medical School and then pursued an OB/GYN residency at the Beth Israel Deaconess Medical Center in Boston, MA. Dr. Dayananda holds a Family Planning Fellowship at Brigham and Women's Hospital/Harvard Medical School in Boston, MA.

shreeja pillaiMSc

Shreeja holds a postgraduate degree in Chemistry and diploma in Drug Regulatory Affairs from the University of Mumbai. Before joining MomJunction, she worked as a research analyst with a leading multinational pharmaceutical company.

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Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

Read full bio of Rebecca Malachi

Reshmi DasMSc

Reshmi Das has over four years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction.

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