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. 2025 Apr 29.
doi: 10.1007/s42000-025-00663-1. Online ahead of print.

Evaluation of ketones intensive measurement in women with gestational diabetes (EVOKING) study

Basilio Pintaudi  1 , Loretta Giunta  2 , Giacoma Di Vieste  3 , Michela Vergani  4 , Matteo Conti  4 , Arianna Pani  5 , Francesco Corrado  6 , Rosario D'Anna  6 , Antonino Di Benedetto  2
Affiliations

Evaluation of ketones intensive measurement in women with gestational diabetes (EVOKING) study

Basilio Pintaudi et al. Hormones (Athens). .

Abstract

Purpose: Women with gestational diabetes mellitus (GDM) are frequently asked to check their ketone levels by measuring ketonuria before breakfast. However, ketosis could be present even before lunch and dinner. Furthermore, blood ketone measurement could be a more accurate test. Our aim was to evaluate the effect of a blood ketone intensive measurement in the detection of ketosis in women with GDM with a negative urinary ketone test.

Methods: This was a single center, observational, prospective study involving consecutive women with GDM. Only women with negative fasting urinary ketone tests were included. During the same gestational weeks (weeks 30-32), all women were asked to perform a blood ketone test before their main meals. Ketosis was defined as the presence for at least 25% of the time of fasting blood ketone levels > 0.1 mmol/L and > 0.2 mmol/L before lunch and dinner.

Results: Overall, a total of 101 women (mean age 34.7 ± 4.8 years, prepregnancy BMI 28.2 ± 5.2 kg/m2) were studied. Blood ketones were present in 37.6% of the cases before breakfast, 13.9% before lunch, and 11.9% before dinner. Women with at least one daily presence of blood ketones composed 40.6% of the sample. Presence of fasting blood ketones was correlated with ketone presence before lunch (r = 0.63, p < 0.0001) and before dinner (r = 0.55, p < 0.0001) and with mean glucose levels (r = 0.23, p = 0.02) 1 h after breakfast.

Conclusion: Blood ketone testing in women with GDM can detect a larger number of ketosis episodes than a urinary ketone test. Intensive blood ketone measurement should be recommended to women with GDM.

Keywords: Blood glucose; Blood ketones; Gestational diabetes; Urinary ketones.

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Conflict of interest statement

Declarations. Ethics approval: All procedures involving human participants were in accordance with the ethical standards of the institutional research committee (Ethics Committee of the University of Messina, prot. 52/18) and with the 1964 Declaration of Helsinki and its later amendments. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: All authors read and approved the final version of the manuscript for publication. Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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