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Diabetic ketoacidosis (DKA) is one of the most serious and life-threatening complications of diabetes mellitus (DM), especially when it occurs during pregnancy, with a prevalence ranging from 0.5% to 3%. Pregnancy is considered a susceptible environment for the development of this type of metabolic imbalance due to its inherent physiological changes. Unspecific symptoms (vomiting, diarrhea, abdominal pain, etc.), especially in pregnant women, and the fact that ketoacidosis can develop even with normal glucose values (defined as euglycemic ketoacidosis), often lead to a delayed diagnosis. Evidence suggests that timely diagnosis and appropriate management of ketoacidosis are crucial in preventing adverse outcomes for both the mother and the fetus. Fetal outcomes are often dichotomous, resulting in either fetal demise (miscarriage/stillbirth) with a prevalence of 10% to 35%, or the birth of a healthy baby, with possible complications primarily related to diabetes mellitus itself. Additionally, case reports of ketoacidosis developing even in non-diabetic women due to other diseases (such as acute pancreatitis, appendicitis), as well as in those with gestational diabetes mellitus (GDM), further emphasize the importance of considering this condition in everyday clinical practice. The aim of this paper is to further elucidate the causes and course of this complication, as well as the outcomes for both mother and fetus, to contribute to a better overall understanding.

Preconception and prenatal monitoring evaluate the condition of the mother's underlying disease and possible complications during pregnancy. Before conception, patients with diabetes should be informed that suboptimal glycoregulation is associated with reduced fertility and pregnancy losses. The task of the perinatologist in pregnancies affected by diabetes mellitus is to prevent complications of the underlying disease, such as hypoglycemic crises. Another important component of prenatal care in diabetic pregnancies is the recognition and prevention of pregnancy complications such as preeclampsia, polyhydramnios, congenital malformations, fetal macrosomia, and infections.

The nutritional needs of diabetic pregnancies are different from normal pregnancies. Differences in nutritional recommendations can also be seen between pregnant women who are using and who are not using insulin therapy. In this literature review, recommendations for different meal proportions of carbohydrates, proteins, and fats in the diets of pregnant women with diabetes mellitus are listed. Different meal plans were also addressed in this group of patients. The role of exercise in the management of diabetes in pregnancy is undeniable and different approaches found in the literature are presented.

Diabetes mellitus is a metabolic disorder that can occur before pregnancy, be detected during pregnancy, or develop during pregnancy. Therapeutic modalities available today significantly facilitate glycoregulation during pregnancy and childbirth. This review presents different insulin regimens, as well as the advantages and disadvantages of oral antidiabetic agents use with a special focus on hypoglycemia. The importance of maintaining optimal glycemic levels and educating patients in blood glucose self-measurement is explained.