Pregnancy Outcomes in Women After Bariatric Surgery Compared With Obese and Morbidly Obese Controls

Lesko, Jennifer; Peaceman, Alan M.

doi:10.1097/aog.0b013e318239060e

Cited by 114 publications

(86 citation statements)

References 25 publications

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“…This is in accordance with our current study, providing further evidence to support the consideration of postprandial hypoglycaemia as a frequent and potentially harmful sideeffect of OGTT screening in pregnancy after RYGB. Third, some studies have reported an increased incidence of SGA offspring after gastric bypass surgery as well as a trend towards higher perinatal morbidity [13,14,41]. Therefore, our finding that fetal growth of RYGB offspring was associated with the glucose nadir during the OGTT might be of importance, possibly suggesting that the higher level of glycaemic variability and incidence of postprandial hypoglycaemia after gastric bypass has an impact on fetal development.…”

Section: Discussionmentioning

confidence: 64%

“…Previous retrospective reports and register studies have addressed pregnancy complications and pregnancy outcomes following gastric bypass and have demonstrated beneficial effects such as reduced incidence of pre-existing and gestational diabetes mellitus (GDM) [8,9], possibly contributing to a lower prevalence of large for gestational age (LGA) offspring [10][11][12]. However, a marked increase in the prevalence of small for gestational age (SGA) neonates, along with a small increase in the rates of stillbirths or neonatal deaths, indicates a higher risk for perinatal morbidity and mortality [13,14]. In addition, studies in non-pregnant women suggest that gastric bypass surgery is also characterised by an exaggerated postprandial rise in blood glucose followed by hyperinsulinaemic hypoglycaemia, despite long-term improvements in type 2 diabetes onset or management [15].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of glucose regulation in pregnancy after gastric bypass surgery

et al. 2017

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Aims/hypothesis Roux-en-Y gastric bypass (RYGB) surgery is characterised by glycaemic variability. Prospective studies of glucose metabolism in pregnancy after RYGB are not available, therefore this study aimed to evaluate physiological alterations in glucose metabolism in pregnancy following RYGB. Methods Sixty-three pregnant women (25 who underwent RYGB, 19 non-operated obese control women and 19 normal weight control women) were included. Frequently sampled 3 h OGTTs and 1 h IVGTTs were performed between 24 and 28 weeks of gestation and, in a subgroup, were repeated at 3-6 months after delivery. Results We observed major alterations in glucose kinetics during the OGTT, including an early increase in plasma glucose followed by hypoglycaemia in 90% of women who had previously undergone RYGB. The higher degree of glycaemic variability in this group was accompanied by increased insulin, C-peptide and glucagon concentrations after oral glucose load, whereas no differences in insulin response were observed after parenteral glucose administration (RYGB vs normal weight). IVGTT data suggested improved insulin sensitivity (mean difference 0.226 × 100.104, 0.348]; p < 0.001) and disposition index in pregnancies after RYGB when compared with obese control women. However, subtle alterations in insulin action and beta cell function were still observed when comparing women who had undergone RYGB with the normal-weight control group. Moreover, we observed that fetal growth was associated with maternal glucose nadir levels and insulin secretion in offspring of those who had previously undergone RYGB. Conclusions/interpretation Pregnancies after RYGB are affected by altered postprandial glucose, insulin and C-peptide dynamics. Insulin sensitivity is improved by RYGB, although subtle alterations in beta cell function are observed. Longitudinal studies are needed to assess potential consequences for fetal development and pregnancy outcomes.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Assessment of glucose regulation in pregnancy after gastric bypass surgery

et al. 2017

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“…Bariatric surgery was associated with a reduced risk of GDM and LGA infants, shorter gestation and an increased risk for SGA infants [111]. An increased risk of IUGR and SGA infants is consistently demonstrated also in smaller studies [112,113,114]. However, reduced risks of preeclampsia, GDM, hypertension, macrosomia and congenital malformations are consistently reported after bariatric surgery [114].…”

Section: Pregnancy After Bariatric Surgerymentioning

confidence: 99%

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

et al. 2017

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Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

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“…27 Finally, bariatric surgery may increase the risk of small for gestational age infants, perhaps in part due to nutrient deficiencies resulting from malabsoption after surgery. 28 The American College of Obstetrics and Gynecology Practice Bulletin and a clinical practice guideline produced by a consortium of the American Association for Clinical Endocrinologists, The Obesity Society, and the American Society for Metabolic and Bariatric Surgery recommend micronutrient screening in pregnant women after bariatric surgery. 19,20 Based on expert opinion and supplemented by case reports of observed nutrient deficiencies after bariatric surgery, these guidelines recommend testing for relevant micronutrient deficiencies in all individuals every 3-4 months during the first year after bariatric surgery and annually thereafter.…”

Section: Figmentioning

confidence: 99%

Laboratory Testing for and Diagnosis of Nutritional Deficiencies in Pregnancy Before and After Bariatric Surgery

Gadgil

Chang

Richards

et al. 2014

Journal of Women's Health

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Objective: Bariatric surgery can reduce the risk of obesity-related complications of pregnancy, but may cause essential nutrient deficiencies. To assess adherence to laboratory testing guidelines, we examined frequency of testing for and diagnosis of deficiency during preconception and pregnancy using claims data in women with a delivery and bariatric surgery. Methods: Retrospective analysis of claims from seven Blue Cross Blue Shield plans between 2002 and 2008. We included women with a delivery and bariatric surgery within the study period. We used common procedural terminology (CPT) and ICD-9 codes to define laboratory testing and deficiencies for iron, folate, vitamin B12, vitamin D, and thiamine. Using Student's t-test and chi-square testing, we compared frequency of laboratory tests and diagnoses during 12 months preconception and 280 days of pregnancy between women with pregnancy before versus after surgery. We used multivariate logistic regression to evaluate for predictors of laboratory testing. Results: We identified 456 women with pregnancy after bariatric surgery and 338 before surgery. The frequency of testing for any deficiency was low (9%-51%), but higher in those with pregnancy after surgery ( p < 0.003). The most common deficiency was vitamin B12 (12%-13%) with pregnancy after surgery ( p < 0.006). Anemia and number of health provider visits were independent predictors of laboratory testing. Conclusion: Women with pregnancy after bariatric surgery were tested for and diagnosed with micronutrient deficiencies more frequently than those with pregnancy before surgery. However, most laboratory testing occurred in less than half the women and was triggered by anemia. Increased testing may help identify nutrient deficiencies and prevent consequences for maternal and child health.

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Pregnancy Outcomes in Women After Bariatric Surgery Compared With Obese and Morbidly Obese Controls

Abstract: Bariatric surgery is associated with reduction in gestational diabetes in a subsequent pregnancy, but possibly at the expense of an increase in SGA neonates.

Cited by 114 publications

References 25 publications

Assessment of glucose regulation in pregnancy after gastric bypass surgery

Assessment of glucose regulation in pregnancy after gastric bypass surgery

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Laboratory Testing for and Diagnosis of Nutritional Deficiencies in Pregnancy Before and After Bariatric Surgery

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