Pregnancy brings numerous changes to a woman's body, and monitoring health becomes particularly important during these nine months. One aspect that healthcare providers often check is the presence of ketones in urine during pregnancy. But what exactly are ketones, why do they appear in urine, and what does their presence mean for expectant mothers? This comprehensive guide explores everything you need to know about ketones in urine during pregnancy, from causes to management strategies.

What Are Ketones and Why Do They Appear in Urine?

Ketones are chemical compounds produced when your body breaks down fat for energy instead of using glucose (sugar). Normally, your body prefers to use carbohydrates as its primary energy source. However, when carbohydrate intake is insufficient or when your body cannot effectively use glucose, it switches to burning fat, resulting in ketone production.

During pregnancy, several factors can lead to ketone production:

• Morning sickness: Severe nausea and vomiting (hyperemesis gravidarum) can make it difficult to maintain adequate food and fluid intake.

• Gestational diabetes: This pregnancy-specific form of diabetes can affect how your body processes glucose.

• Skipping meals or fasting: Missing meals can cause blood sugar to drop, triggering ketone production.

• Increased metabolic demands: Pregnancy increases your body's energy needs, which can sometimes lead to ketosis if these needs aren't met.

When ketones build up in your bloodstream, they spill into your urine, where they can be detected through simple testing.

Why Are Ketones in Urine Monitored During Pregnancy?

Healthcare providers monitor ketones in urine during pregnancy for several important reasons:

1. Indication of Nutritional Status

The presence of ketones may signal that you're not getting enough calories or carbohydrates, or that you're experiencing excessive vomiting that prevents proper nutrition.

2. Connection to Gestational Diabetes

For women with gestational diabetes, ketones in urine can indicate that blood sugar management needs adjustment. When blood sugar is too high or too low, ketone production may increase.

3. Potential Risks to Fetal Development

Persistent, high levels of ketones during pregnancy have been associated with potential impacts on fetal brain development. While research is ongoing, healthcare providers take a cautious approach to monitor and manage ketone levels.

4. Dehydration Assessment

Ketones in urine can also indicate dehydration, which carries its own risks during pregnancy, including reduced amniotic fluid levels and increased risk of preterm labor.

How Common Are Ketones in Urine During Pregnancy?

The detection of ketones in urine during pregnancy is relatively common, especially during the first trimester when morning sickness peaks. Research suggests that:

• Up to 30% of pregnant women may have detectable ketones in their morning urine samples at some point.

• The prevalence is higher in women with hyperemesis gravidarum, affecting up to 80% of these cases.

• Women with gestational diabetes have a roughly 20-30% chance of developing ketonuria (ketones in urine) if their condition isn't optimally managed.

Testing for Ketones in Urine During Pregnancy

When Testing Occurs

Routine testing for ketones in urine may be recommended:

• At regular prenatal checkups, particularly for high-risk pregnancies

• When a woman has been diagnosed with gestational diabetes

• When a woman reports severe morning sickness or reduced food intake

• If symptoms of diabetic ketoacidosis (a serious condition) are suspected

How Testing Works

Testing for ketones is straightforward and non-invasive:

1. Urine dipstick tests: These are commonly used at medical appointments. A test strip is briefly dipped in a urine sample, and the color change indicates the ketone level.

2. Home testing kits: Available at pharmacies, these allow pregnant women to monitor ketone levels between appointments if recommended by their healthcare provider. 

Using urine protein test strips at home is a helpful way to keep an eye on kidney health between appointments.

Ketone levels are typically reported as:

• Negative (no ketones)

• Trace amounts

• Small (+)

• Moderate (++)

• Large (+++)

In some cases, abnormal ketone levels may occur alongside changes in urine pH, which can further help assess your body’s acid-base balance during pregnancy.

What Do Different Ketone Levels Mean in Pregnancy?

Negative or Trace Amounts

This is considered normal and generally doesn't require intervention.

Small to Moderate Levels

May indicate:

• Insufficient caloric intake

• Effects of morning sickness

• Mild dehydration

• Need for adjustments in diet or fluid intake

Large Amounts

May signal:

• Significant nutritional deficiency

• Poorly controlled gestational diabetes

• Severe dehydration

• Possible diabetic ketoacidosis (in conjunction with high blood sugar)

Risks Associated with Elevated Ketones During Pregnancy

Maternal Risks

Persistent or high levels of ketones may be associated with:

• Dehydration: Can lead to electrolyte imbalances and increased risk of urinary tract infections.

• Diabetic ketoacidosis: A serious condition that can develop rapidly in women with diabetes, including gestational diabetes.

• Nutritional deficiencies: May impact maternal health and energy levels.

If you're seeing foam or cloudiness in your urine, it might also indicate the presence of protein in urine, a sign that deserves medical attention.

Fetal Risks

Research suggests potential concerns including:

• Neurodevelopmental impacts: Some studies indicate associations between maternal ketosis and changes in fetal brain development.

• Birth weight variations: Both higher and lower birth weights have been observed in pregnancies with recurring maternal ketosis.

• Indirect effects: Poor maternal nutrition or uncontrolled diabetes can impact fetal growth and development.

Managing and Preventing Ketones in Urine During Pregnancy

Dietary Strategies

1. Regular, balanced meals: Eating small, frequent meals can help maintain stable blood sugar levels.

2. Adequate carbohydrate intake: Include complex carbohydrates that release energy slowly.

3. Protein-rich foods: Help stabilize blood sugar and provide essential nutrients.

4. Healthy fats: Incorporate sources like avocados, nuts, and olive oil.

Sample meal plan to prevent ketosis:

• Breakfast: Whole grain toast with nut butter and banana

• Mid-morning snack: Greek yogurt with berries

• Lunch: Quinoa salad with vegetables and chickpeas

• Afternoon snack: Apple with cheese

• Dinner: Baked salmon with sweet potato and steamed broccoli

• Evening snack: Whole grain crackers with hummus

Hydration

Maintaining adequate fluid intake is crucial:

• Aim for at least 8-10 cups (64-80 oz) of fluid daily

• Include electrolyte-containing beverages if experiencing vomiting

• Monitor urine color—pale yellow indicates good hydration. 

In some cases, abnormal ketone levels may occur alongside changes in urine pH, which can further help assess your body’s acid-base balance during pregnancy.

Managing Morning Sickness

For women with severe nausea and vomiting:

• Try small, frequent meals rather than three large ones

• Keep bland snacks like crackers by the bedside for morning consumption

• Consider ginger tea or other pregnancy-safe anti-nausea remedies

• Consult with healthcare providers about prescription anti-nausea medications if needed

Blood Sugar Management

For women with gestational diabetes:

• Follow the recommended gestational diabetes diet plan by your physician

• Monitor blood sugar levels as advised

• Take prescribed medications as directed

• Maintain regular physical activity as approved by healthcare providers

Monitoring high glucose in urine is especially important if you're managing gestational diabetes or at risk for it.

When to Seek Medical Attention

Contact your healthcare provider promptly if you experience:

• Moderate to large ketones in your urine, especially if you have diabetes

• Inability to keep food or fluids down for more than 24 hours

• Signs of dehydration (extreme thirst, dry mouth, dizziness)

• Symptoms of diabetic ketoacidosis, including:

• Excessive thirst

• Frequent urination

• Nausea and vomiting

• Abdominal pain

• Confusion

• Fruity-smelling breath

• Rapid breathing

Monitoring Your Progress

If ketonuria was detected, your care plan might include:

• Follow-up urine or blood ketone testing
  

• Nutritional counseling
  

• Blood glucose monitoring, especially if diabetes is present
  

• Growth checks via ultrasound to assess fetal development

Keeping a food and hydration journal can also help identify triggers and support personalized care.

For a full picture of kidney performance, your doctor may look at additional markers beyond ketones, such as the urine protein/creatinine ratio.

The Bottom Line

Ketones in urine during pregnancy can be a temporary signal or a more serious sign. With the right steps, most people can reduce or eliminate ketones and continue a healthy pregnancy.

Here’s what to remember:

• Eat often and stay hydrated
  

• Include enough carbs daily
  

• Seek help for persistent vomiting or ketone readings
  

• Monitor for gestational diabetes

Your body is working hard to support new life—and small adjustments can make a big difference. Always partner with your care team if you’re unsure.

Ready to Take Control of Your Pregnancy Health?

Ribbon Checkup offers at-home test kits that help you track important pregnancy markers, including urine ketones. Fast results, clinical accuracy, and peace of mind—all from home.

Frequently Asked Questions About Ketones in Pregnancy

Can a ketogenic diet be followed during pregnancy?

Most healthcare providers strongly advise against following a ketogenic or very low-carbohydrate diet during pregnancy. These diets deliberately induce ketosis, which is generally not recommended during pregnancy due to potential risks to fetal development.

Do all women need to test for ketones during pregnancy?

Not all women need regular ketone testing. Your healthcare provider will recommend testing based on your individual risk factors and circumstances.

Can exercise affect ketone levels during pregnancy?

Intense exercise without adequate carbohydrate intake can potentially increase ketone production. Pregnant women should discuss appropriate exercise intensity with their healthcare providers and ensure proper nutrition before and after workouts.

How quickly can ketone levels change?

Ketone levels can change relatively quickly—within hours—based on food intake, hydration status, and activity levels. This is why monitoring may need to be more frequent during high-risk situations.

Written by Abel Tamirat, MD
Dr. Abel Tamirat is a licensed General Practitioner and ECFMG-certified international medical graduate with over three years of experience supporting U.S.-based telehealth and primary care practices. As a freelance medical writer and Virtual Clinical Support Specialist, he blends frontline clinical expertise with a passion for health technology and evidence-based content. He is also a contributor to Continuing Medical Education (CME) programs.

 

Related Resources

1. Protein in Urine: What It Means for Your Health
Learn how protein in urine can indicate kidney function issues during pregnancy and why it’s often monitored alongside ketones.

2. Understanding Fasting Glucose Levels: A Comprehensive Guide
Explore the importance of stable blood sugar levels during pregnancy, especially in managing gestational diabetes and preventing ketone buildup.

3. How to Tell If You’re Dehydrated: Signs, Symptoms & Tests
Dehydration is a common cause of ketones in urine. This guide helps you recognize the warning signs and stay safely hydrated.

 

References

Clinic, C. (2023, August 11). Ketones In Urine During Pregnancy: What It Means. Retrieved May 16, 2025, from Cleveland Clinic website: https://my.clevelandclinic.org/health/symptoms/23157-ketones-in-urine-during-pregnancy 

https://www.facebook.com/WebMD. (2017, June 7). What Is Ketonuria? Retrieved May 16, 2025, from WebMD website: https://www.webmd.com/diabetes/what-is-ketonuria 

Robinson, H. L., Barrett, H. L., Foxcroft, K., Callaway, L. K., & Dekker Nitert, M. (2017). Prevalence of maternal urinary ketones in pregnancy in overweight and obese women. Obstetric Medicine, 11(2), 79–82. https://doi.org/10.1177/1753495x17743163 

Robinson, H. L., Barrett, H. L., Foxcroft, K., Callaway, L. K., & Marloes Dekker Nitert. (2017). Prevalence of maternal urinary ketones in pregnancy in overweight and obese women. Obstetric Medicine, 11(2), 79–82. https://doi.org/10.1177/1753495x17743163 

Tanner, H. L., Marloes Dekker Nitert, Callaway, L. K., & Barrett, H. L. (2020). Ketones in Pregnancy: Why Is It Considered Necessary to Avoid Them and What Is the Evidence Behind Their Perceived Risk? Diabetes Care, 44(1), 280–289. https://doi.org/10.2337/dc20-2008