Ketones in Pregnancy: Why Is It Considered Necessary to Avoid Them and What Is the Evidence Behind Their Perceived Risk?
Abstract
Current dietary advice for women with gestational diabetes mellitus is to avoid diets that result in elevated ketone levels. This guidance stems from a concern that maternal ketones are associated with poor fetal and childhood outcomes, including reduced childhood intelligence quota. The evidence behind these guidelines is conflicting and inconsistent. Given that dietary counseling is the initial treatment strategy for women with diabetes in pregnancy, it is important that clinicians understand the concern regarding maternal ketones. This review examines the physiology of ketogenesis in pregnancy, the prevalence of elevated maternal ketone levels, and the relationship between maternal ketones and fetal and childhood outcomes.
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A key concern with carbohydrate restriction is the rise in maternal free fatty acids and ketone production, which can lead to pre-eclampsia, foetal demise, and neurodevelopmental complications.
“A key concern with carbohydrate restriction is the rise in maternal free fatty acids and ketone production, which can lead to pre-eclampsia [68], foetal demise [68], and neurodevelopmental complications [69].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [69]
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Cheong, L., Law, L. S.-C., Tan, L. Y. L., Amal, A. A.-A., Khoo, C. M., & Eng, P. C. (2025) · Nutrients · doi:10.3390/nu17071210 · Cited by 14 · see citing works
- Authors
- Tanner, H. L., Dekker Nitert, M., Callaway, L. K., & Barrett, H. L.
- Affiliations
- The University of Queensland (AU)
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, St. Lucia, Queensland, Australia
- Royal Brisbane and Women's Hospital (AU)
- Corresponding author
- Barrett, Helen L.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2020-12-14
- Volume
- 44
- Issue
- 1
- Pages
- 280-289
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W3113758882
- Cited by
- 46
- References
- 8
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 12 · 2023: 5 · 2022: 5 · 2021: 4
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-06-01)
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- ketones, ketosis, gestational diabetes mellitus, pregnancy, ketogenesis, nutrition counseling, fetal outcomes, child intelligence, dietary recommendations
- MeSH terms
- Child, Diet, Female, Humans, Ketones, Pregnancy, Prenatal Care, Diabetes, Gestational
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