Ketones in Urine During Pregnancy

What does it mean to have ketones in your urine during pregnancy?

Having ketones in your pee (urine) during pregnancy may be a sign that you have gestational diabetes, are dehydrated or aren’t getting proper nutrition.

Ketones develop when your body breaks down fat to use for energy. Your body prefers to use glucose (sugar) for energy. When you don’t have enough of it or don’t absorb it correctly, your body uses body fat instead.

A trace (small) amount of ketones is generally OK. You likely won’t have any related symptoms. But high levels of ketones can be harmful. You may have symptoms like:

• Excessive thirst despite drinking a lot of water
• Feeling overly tired
• Headache

Most pregnancy care providers don’t regularly test for ketones. But they might if you have unusually high blood glucose test results or have signs of dehydration. Your provider is the best person to decide whether the amount of ketones in your urine needs treatment right away.

What is a normal range of ketones in urine during pregnancy?

Only your healthcare provider can decide what’s normal for you. In general, ketone levels of less than .5 millimolar (mM) are within a normal range.

What causes ketones in urine during pregnancy?

Possible causes of ketones in your urine include:

• Unmanaged diabetes (the most common cause of high ketones)
• Dehydration
• Excessive vomiting or diarrhea due to morning sickness
• Skipping meals or snacks
• Eating a low-carbohydrate (keto) diet
• Over-exercising
• Underlying infection or illness

How is this treated?

The treatment for ketones during pregnancy depends on the cause. For example:

• For gestational diabetes, you’ll need to adjust what you eat to manage your glucose levels. Your provider may prescribe insulin if eating changes alone aren’t enough.
• For severe morning sickness, your provider may prescribe medication to help with nausea. Or you may need IV fluid hydration.
• Eating more calories and/or carbs can help if ketones in your pee are due to nutrition issues.

What are the possible complications or risks of not treating it?

Research is mixed on whether elevated ketone levels are harmful to the fetus. But very high ketone levels — typically from unmanaged diabetes — are dangerous to you and the fetus. It can be a sign of diabetes-related ketoacidosis (DKA), a life-threatening emergency.

DKA is rare in gestational diabetes. But people with Type 1 diabetes (T1D) are at increased risk. If you’re pregnant and have T1D, you can get DKA at lower blood sugar levels than when you’re not pregnant. It can also develop more rapidly.

If you have T1D, your healthcare provider may recommend checking for ketones with at-home test strips if your blood sugar reaches 200 mg/dL. This is to try to catch DKA as soon as possible so you can get treatment.

Can this symptom be prevented?

It’s not always possible to prevent ketones during pregnancy. But the following tips can help keep them at a healthy level:

• Don’t skip meals.
• Drink a lot of water to stay hydrated.
• Eat at least three meals and three snacks daily. Having a snack before bed can especially help.
• Eat a variety of carbohydrates (like rice, oats, whole grain bread and pasta). If you have gestational diabetes, ask a dietitian what the best carbohydrate sources are for you.
• Include protein in each meal. Some options are eggs, beans, meat or tofu.

If you have diabetes, check your glucose as recommended by your provider. See your healthcare provider regularly so they can make sure your treatment plan is working well.

When should this symptom be treated by a healthcare provider?

If you have ketones in your urine, your healthcare provider will monitor you throughout pregnancy. They’ll help you keep ketones in a healthy range.

See your provider if you have a history of ketones in your pee and any of the following symptoms:

• Fever
• Vomiting or diarrhea
• A higher-than-usual blood glucose level with no explanation (if you have diabetes)
• A ketone level that’s higher than your usual