Your body burns glucose (sugar) for energy. If your cells don't get enough glucose, your body burns fat for energy instead. This produces ketones, which show up in your urine. During pregnancy, it could indicate gestational diabetes, poor diet or needing to eat more calories.
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.
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.
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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.
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:
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.
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Some of the most common causes of ketones in your urine are:
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:
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:
DKA is rare in pregnancy except when glucose values are not controlled, or there is undiagnosed diabetes that existed prior to pregnancy
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Yes, being dehydrated can cause ketones in your pee.
Detecting ketones in urine is most common, but ketones can also show up in blood tests.
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.
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:
Drinking more water can help with ketone levels because dehydration can cause your body to create ketones.
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:
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:
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.
Last reviewed on 06/27/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy