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Obstetrics & Gynecology 2002;99:877-879
© 2002 by The American College of Obstetricians and Gynecologists
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CASE REPORTS

Nonimmune "Fulminant" Type 1 Diabetes Presenting With Diabetic Ketoacidosis During Pregnancy

Maki Otsubo, MD, Tanri Shiozawa, MD, Kaoru Kimura, MD and Ikuo Konishi, MD

Department of Obstetrics and Gynecology, Koseiren Shinonoi General Hospital, Nagano, Japan; and Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan

Address reprint requests to: Tanri Shiozawa, MD, Shinshu University School of Medicine, Department of Obstetrics and Gynecology, 3-1-1 Asahi, Matsumoto, 390-8621, Japan; E-mail: tanri{at}hsp.md.shinshu-u.ac.jp.

ABSTRACT

BACKGROUND: Ketoacidosis in pregnant women with previously undiagnosed diabetes is rare. Although insulin-dependent diabetes has recently been classified as either autoimmune (type 1A) or nonimmune (type 1B; "chronic" and "fulminant" subtypes), the clinical characteristics of diabetes in such settings are not fully understood.

CASE: We report two pregnant patients with previously undiagnosed diabetes. They presented with severe diabetic ketoacidosis characterized by an abrupt onset, normal, or slightly elevated level of glycosylated hemoglobin, absence of diabetes-related autoimmune antibodies, and features typical of the "fulminant" subtype of nonimmune diabetes. The fetuses died in utero, and the mothers became insulin dependent.

CONCLUSION: The "fulminant" subtype of diabetes may be associated with fetal death.




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Copyright © 2002 by the American College of Obstetricians and Gynecologists.