Ketones in Urine During Pregnancy

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

Ketones in urine during pregnancy occur when your body breaks down fat and uses it for energy. This happens when you don’t have enough glucose (sugar) in your blood or don't absorb glucose correctly. Your body prefers to use glucose for energy. Without glucose, your body uses fat instead. This breakdown of fat produces ketones. Your kidneys release ketones, and it shows up in your urine and blood. Having ketones in your urine is called ketonuria. Treatment for ketonuria during pregnancy depends on the cause. Your pregnancy care provider can tell if you have ketones in your pee with a simple urine test (urinalysis).

If you have ketones in your urine during pregnancy, it may be a sign that you aren’t consuming enough calories or that you have gestational diabetes. Your healthcare provider is the best person to decide whether the amount of ketones in your urine requires immediate treatment. You can usually manage your ketone levels with diet and lifestyle changes or medication.

Ketones and gestational diabetes

One of the most common causes of ketones in your urine is unmanaged diabetes. The hormonal changes in pregnancy affect your body’s ability to use insulin. Insulin is a hormone that allows your body to use glucose for energy. When you can’t use glucose for energy, glucose builds up in your blood and causes gestational diabetes. It also leads to your cells using fat for energy, which increases ketone production. Finding ketones in your urine may be a sign that your blood sugar is off balance or that you’re not consuming enough carbohydrates. If your blood sugar and ketone levels can’t be managed with diet and lifestyle modifications, you may need insulin.

Untreated diabetes during pregnancy can lead to high levels of sugar (glucose) crossing into the placenta and to your baby.

Can ketones in urine harm my baby?

Ketones do cross the placenta to the baby and there is some concern that a large amount can affect the baby's cognitive abilities. Occasional traces of ketones in your urine with no other symptoms is usually OK. However, consistently high ketone readings or symptoms of excess ketones could affect your pregnancy.

There isn’t conclusive data on the exact correlation, so routine checking for ketones is not common.

Why do I have ketones in my urine if I don't have diabetes?

You can have ketones in your urine and not have diabetes. Diabetes is just one of the factors that can cause ketones in your urine. Other reasons you may have ketones in your urine are:

• Lack of carbohydrates in your diet.
• Fasting or going too long between meals.
• Eating disorders.
• Extreme workouts or over-exercise.
• Vomiting.

Most providers don't test for ketones in your urine except when there’s unusually high glucose in your blood, or in cases of dehydration.

What are the most common causes of ketones in urine?

Some of the most common causes of ketones in your urine are:

• Uncontrolled diabetes.
• Underlying infection or illness.
• Over-exercise.
• Dehydration.
• Excessive vomiting or diarrhea due to morning sickness.
• Not eating enough food the day before.
• Skipping meals or snacks.
• Eating a low carbohydrate diet.

What are the symptoms of ketones in urine during pregnancy?

You may not have any symptoms of ketones in your urine. During pregnancy, your provider will check your urine regularly. If they notice unusual ketone levels, they may recommend further testing. Especially if you also have symptoms like:

• High blood glucose levels in your prenatal blood work.
• Excessive thirst despite drinking enough water.
• Fatigue and being overly tired.
• Frequent vaginal or bladder infections.

If you’ve been diagnosed with diabetes or gestational diabetes (diabetes during pregnancy), you’re at risk for diabetes-related ketoacidosis (DKA). DKA is a life-threatening emergency. Symptoms of DKA include:

• Extremely high blood glucose levels.
• Extreme feelings of thirst.
• Blurred vision.
• Increased urination.
• Feeling lethargic.
• Fruity smell to your breath.

DKA is rare in pregnancy except when glucose values are not controlled, or there is undiagnosed diabetes that existed prior to pregnancy

Can dehydration cause ketones in urine?

Yes, being dehydrated can cause ketones in your pee.

How do you test for ketones in your body?

Detecting ketones in urine is most common, but ketones can also show up in blood tests.

• Urine ketone test: A urine ketone test measures the number of ketones in your pee. It's a strip that will turn a certain color depending on whether ketones are present. You can purchase urine ketone tests at your local pharmacy, or your healthcare provider may write you a prescription. Follow the instructions to be sure you are using the test properly.
• Blood ketone test: Your healthcare provider measures the number of ketones in your blood using a blood sample.

How do I test for ketones in my urine at home?

You’ll check your urine for ketones as soon as you get up each morning (your first urine). Most ketone test strips are dip-and-read, which means you catch your pee in a clean container and then dip the end of the strip in your pee.

Most strips display results as a color range. Certain colors indicate no ketones are detected, and others indicate ketones have been detected. Once your strip changes color, compare the color to the color guide on the packaging. Your ketone reading should be negative or minimal. Contact your healthcare provider if the ketone level in your pee is moderate or large. Your results may vary depending on factors like diet and activity level, so it’s best to seek advice from your provider based on your unique situation.

There is no need to check for ketones in your urine unless your provider recommends it.

How are ketones in urine treated when you’re pregnant?

It depends on the cause. If you have gestational diabetes, you'll need to change your diet to manage glucose levels. Your provider may prescribe insulin if diet alone doesn't help. If you have morning sickness accompanied by chronic vomiting, your provider may prescribe medication to help with nausea or have you get IV fluid hydration.

If ketones in your urine are due to inadequate nutrition, your healthcare provider may recommend eating more calories or eating more frequently.

The following dietary tips will help to keep your ketones at a healthy level:

• Don't skip meals.
• Drink a lot of water or other fluids to stay hydrated.
• Eat at least three meals and three snacks daily. Having a snack before bed has been associated with lower ketone levels.
• Eat a variety of carbohydrates (rice, oats, whole grain bread and pasta).
• Include protein in each meal. Some good choices are eggs, beans, meat or tofu.

Does drinking water lower ketones during pregnancy?

Drinking more water can help with ketone levels because dehydration can cause your body to create ketones.

How can ketones in urine during pregnancy be prevented?

Sometimes it can’t be prevented or is beyond your control. However, there are things you can do to help keep your ketones at a healthy level:

• Don’t skip meals or try to diet during pregnancy.
• Eat frequent snacks.
• Stay hydrated. You should increase your water consumption during pregnancy.
• Exercise a moderate amount every day.

When should my healthcare provider treat ketones in urine?

If you have ketones in your urine, your healthcare provider will monitor you throughout pregnancy and help you keep ketones in a healthy range. If you have a history of ketones in your pee plus any of the following symptoms, contact your provider:

• A fever.
• Vomiting or diarrhea.
• A higher than usual blood glucose level with no explanation (for people with diabetes).
• The amount of ketones in your pee is higher than your typical levels.

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

Only your healthcare provider can decide what is normal for you. Generally speaking, ketone concentrations of less than .5 millimolar are considered in a normal range.

A note from Cleveland Clinic

Your healthcare provider may monitor your ketone levels if you have gestational diabetes, are at risk for diabetes or have had abnormal ketone levels. Having trace amounts of ketones in your urine during pregnancy isn't usually a cause for worry. The easiest way to test for ketones is to use test strips that change color when it comes in contact with your pee. In most cases, you can manage ketone levels with diet and lifestyle changes or with medication.