ketones in urine, 2nd trimester

[ladycarlotta]

Hi,

I had my routine midwife appointment today and she commented that my urine dip test indicated ketones in my urine. I've noticed I've lost a few pounds lately and she said she thought I was probably eating less than I was burning off and not to worry, just to make sure my diet is healthy.

I'm 25 weeks and my BMI is 33. I haven't weighed myself that often but I know I gained maybe 6lb earlier in the second trimester and that 3 or 4 have come off again recently. Given my BMI I feel I can stand to lose it, but since going away and looking it up I've got a bit worried that it's a sign of gestational diabetes?

I don't have any info besides what she said and a urine test is pretty binary so I feel I can't gauge any of this. Should I be concerned? Midwife did not seem to be. I already opted in to have the glucose tolerance test at 28 weeks so I guess that'll give more information, I'm just really worried now that this is abnormal and that I could/should be doing more.

Any experience of this please?

I was diagnosed with gestational diabetes around 28 weeks. After that, I really had to change my diet to try to keep blood sugars low. The next time I saw the midwife,she said I had ketones in my urine and said it's a sign that I've gone overboard with the diet and I'm not eating enough. She told me to not starve myself. I ended up on medication for the rest of the pregnancy, but all was fine. Have a look at your diet, try to improve it until your gtt. It's not the end of the world to have GD.

Yep ketones in my urine test was the first sign of GD for me. Just start to manage your diet a little and then see what the results of the glucose test are at 28 weeks. I didn't have to take any medication for mine, just diet controlled. Try not to panic, it's fairly common xxx

Hey OP. Ketones is a sign of GD, I was diagnosed by NHS at 26 weeks but i was testing my bloods a couple of weeks beforehand due to my Dad being Type 2. I’m now 36+5 with polyhydramnios and a big baby. I’m on metaformin and insulin to keep it under control which has made it so much better for me. I’ve only put on 3kg since falling pregnant and that’s what my baby is weighing (BMI was 35+ at booking). Don’t worry about weight gain but do make sure you’re eating 3 meals a day and snacking. I got pulled up on that I’m not eating enough after a urine dip a few weeks ago. Also, what might raise one persons bloods might not raise yours and vice versa, I can eat McDonald’s and a McFlurry and my bloods are fine, but can’t eat beans on toast. So if you do have GD, the first week or so is trial and error. Good luck xx

Thanks to all 3 of you! I really thought I was doing OK with diet and gentle exercise - I'll start a food diary to keep myself honest but looking at the advice for managing GD I thought I was doing most of it anyway, eg complex carbs, protein, not skipping meals etc. I've been quite averse to sweets and junk food since being pregnant so that hasn't been hard to avoid. I know I really need to sit down with it all and get serious. Interesting to hear @AimeeLou84 that different things spike different people's blood sugar - what a pain!

Panicking a bit reading up about the terrible effect GD can have on baby - I had a lot of losses before this pregnancy so I feel horribly guilty that I am not growing her as healthily as I should be - but I know this is not helpful.

Hi OP, ketones in your urine can be for a few different reasons. Something simple like dehydration being one of them. Do you feel like you're drinking enough water? Weightloss or under eating can do it too and you mentioned you've had some weightloss recently.

Yes ketones in urine can be a sign of GD, but you'd expect to have glucose in your urine in that case also. Ketones happen in diabetics when sugars are high, glucose can't be transported to cells and broken down for energy, and your body breaks down fat instead. The waste product of fat breakdown is then ketones. So the fact that there was no glucose is a good sign. Have you any other symptoms of GD ie thirst, baby measuring large or excess fluids around baby?

In my hospital the GD test happens between 24-28 weeks. I wonder could you get in touch with your midwife and request for it to be done sooner than 28 weeks for your peace of mind? At least might make you feel better to have it done and have an answer. Best of luck!

I agree with @remaininghopeful23 , I would call your midwife and ask to bring your GTT forwards to next week or the following week. Would be reasonable to do I think. You could also check another urine later this week and make sure you'd been drinking well so you know dehydration wasn't a factor.

Similar weight to you and the goal I was given throughout was to maintain. No ketones at any of my appointments going up to 28 weeks when I was diagnosed with GD - but there was ketones at the next appointment as I had gone a little overboard with the change in diet!

Knowing what I do know if I was in your position I'd look to make modest changes which may well already be on your radar - swap to wholemeal pasta and bread if you don't already, full fat greek yoghurt, cheese and nuts for snacks. Carbs are still super important so make sure you're getting a helping in some form with every main meal. Then otherwise it's just holding out for a few more weeks for your glucose tolerance test.

these are really useful points/questions, thank you!

I think I've been hydrating adequately but it's been warm so maybe not. My fundal height today was a little bit under the 50th percentile and on my two anatomy scans baby's measurements were all between 35th-50th percentiles so she isn't large and nobody's mentioned polyhydramnios. Good to know one might expect to see glucose in the urine too for GD. I'll ask about moving the GTT forward.

I've not been well lately - nothing bad, just a cold and sinusitis - so maybe I just haven't been eating much. I can't smell or taste much!