Key result
Pregnancies after bariatric surgery are marked by frequent hypoglycemic events and wide glycemic excursions, and OGTT is unreliable for diagnosing gestational diabetes mellitus.
Why the study?
Surgically induced metabolic changes after bariatric surgery benefit mother and child but can lead to adverse pregnancy outcomes, and knowledge about glucose homeostasis could elucidate underlying mechanisms.
How does a history of bariatric surgery affect glucose homeostasis, gestational diabetes mellitus, and fetal growth during pregnancy?
How does a history of bariatric surgery affect glucose homeostasis, gestational diabetes mellitus, and fetal growth during pregnancy?
Standard OGTT is unreliable for diagnosing GDM in post-bariatric surgery pregnancies, which are characterized by significant glycemic variability and hypoglycemia.
Requires hypoglycemia vigilance and non-OGTT GDM screening after bariatric surgery; leaves open validated methods and true incidence.
BACKGROUND: Pregnancies in women with a history of bariatric surgery are becoming increasingly prevalent. Surgically induced metabolic changes benefit mother and child, but can also lead to some adverse pregnancy outcomes. Knowledge about glucose homeostasis in these pregnancies could elucidate some of the mechanisms behind these outcomes. This review focusses on glucose homeostasis and birth weight. METHODS: We considered papers dealing with glucose homeostasis, gestational diabetes mellitus (GDM) and/or small-for-gestational age infants (SGA) in pregnancies with a history of sleeve gastrectomy (SG) or Roux-en-y gastric bypass (RYGB). RESULTS: Since an OGTT is unreliable to diagnose GDM in a pregnancy after bariatric surgery, the true incidence of GDM is unknown. Alternative screening strategies are needed. Furthermore, these pregnancies are marked by frequent hypoglycemic events as well as wide and rapid glycemic excursions, an issue that is very likely underreported. There is a lack of uniformity in reporting key outcomes and a large variation in study design and control population. CONCLUSION: Alteration of glucose homeostasis in a pregnancy after bariatric surgery should be further studied using unequivocal definition of key concepts. Glycemic control may prove to be a modifiable risk factor for adverse pregnancy outcomes such as the delivery of an SGA baby.
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Deleus et al. (2020) conducted a review in Pregnancy after bariatric surgery. Bariatric surgery (sleeve gastrectomy or Roux-en-y gastric bypass) was evaluated on Glucose homeostasis, gestational diabetes mellitus, and birth weight. Pregnancies after bariatric surgery are marked by frequent hypoglycemic events and wide glycemic excursions, and OGTT is unreliable for diagnosing gestational diabetes mellitus.
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