Case series of COVID-19 infection in pregnancy complicated by ketoacidosis and symptomatic breathlessness

Thorne, Iona Steele Samantha Martineau Marcus Girling Joanna

BackgroundThe differential diagnosis of acute shortness of breath in a pregnant woman with COVID-19 is broad. Pregnancy is a ketosis-prone state, which can result in metabolic acidosis and tachypnoea.MethodsWe describe four pregnant women with COVID-19 and breathlessness where ketoacidosis was found to contribute to symptomatic tachypnoea.ResultsOne patient did not have associated COVID-19 pneumonitis, but presented with severe tachypnoea and metabolic acidosis;three women had pneumonitis and metabolic acidosis. Corrective treatment for the metabolic abnormalities resulted in resolution of the ketoacidosis in all cases. No women had coexistent diabetes.ConclusionThis is the first series of COVID-19 in pregnancy complicated by ketoacidosis and symptomatic tachypnoea. Ketoacidosis associated with COVID-19 is an important cause of tachypnoea requiring specific treatment, which should not be overlooked. Potential mechanisms for this are discussed with a framework for interpretation of blood gas results during pregnancy.