Bariatric Surgery and Its Impact on Gestational Diabetes

2017 ◽  
pp. 207-226
Author(s):  
Gil Gutvirtz ◽  
Charlotte Alexander ◽  
Eyal Sheiner
Keyword(s):  
Bariatric Surgery ◽  
Gestational Diabetes

scholarly journals Glucose Homeostasis, Fetal Growth and Gestational Diabetes Mellitus in Pregnancy after Bariatric Surgery: A Scoping Review

2020 ◽  
Vol 9 (9) ◽  
pp. 2732
Author(s):  
Ellen Deleus ◽  
Bart Van der Schueren ◽  
Roland Devlieger ◽  
Matthias Lannoo ◽  
Katrien Benhalima
Keyword(s):  
Diabetes Mellitus ◽  
Bariatric Surgery ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Glucose Homeostasis ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
True Incidence ◽  
History Of ◽  
Adverse Pregnancy

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.

Pregnancy after bariatric surgery: screening for gestational diabetes

BMJ ◽  
2017 ◽  
pp. j533 ◽  
Author(s):  
Safwaan Adam ◽  
Basil Ammori ◽  
Handrean Soran ◽  
Akheel A Syed
Keyword(s):  
Bariatric Surgery ◽  
Gestational Diabetes

P–634 The effect of bariatric surgery on PCOS patients’ obstetrical and neonatal outcomes: A population based study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Bazarah ◽  
H Baghlaf ◽  
A Badeghiesh ◽  
H Dahan
Keyword(s):  
Bariatric Surgery ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Gestational Diabetes ◽  
Cesarean Section ◽  
Multivariate Logistic Regression Analysis ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Multivariate Logistic Regression ◽  
History Of

Abstract Study question Does bariatric surgery (BS) decrease the occurrence of adverse obstetrical and neonatal outcomes in morbidly obese women with polycystic ovarian syndrome (PCOS)? Summary answer Patients with PCOS who underwent BS were at lower risk for gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), than other women with PCOS. What is known already Studies have shown that PCOS in pregnancy is associated with the occurrence of GDM, preeclampsia, PIH, preterm birth (PTB), cesarean section, miscarriage, hypoglycemia, and neonatal death. Patients with PCOS may have an increased risk of obesity compared to the general population, which magnifies the inherent insulin resistance many fold. PCOS patients who underwent bariatric surgery have a marked improvement in menstrual irregularities, hirsutism, T2DM, hypertension, and dyslipidemia. The benefit of bariatric surgery for PCOS patients and the improvement of pregnancy related complications has not been adequately studied, with most studies being small. Study design, size, duration This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database from 2004 to 2014. Using multivariate logistic regression analysis, we compared women with PCOS who underwent BS with a control group consisting of pregnant patients with PCOS of all BMIs who had not had weight reduction operations regarding pregnancy, delivery, and neonatal outcomes. Participants/materials, setting, methods The study group included pregnant PCOS patients who underwent BS and the control group consisted of pregnant patients with PCOS; who delivered between 2004 and 2014. Demographic and clinical characteristics, pregnancy, delivery, and neonatal outcomes were compared. Multivariate logistic regression analysis was performed to control for all statistically different (P < 0.05) confounding effects. Each subject was included once per delivery. Main results and the role of chance We identified 9,096,788 pregnancies during the study period. 141 patients had a history of PCOS and underwent BS. The control group was composed of 14,741 patients with PCOS who didn’t undergo BS. Prevalence of PCOS patients who underwent BS increased from 0/1,000 in 2004 to 14.6/1,000 in 2014(p = 0.001). Those who underwent BS were more likely to be older than 35-years(42.6% vs. 18.7%, p < 0.0001), obese at delivery(44.7% vs. 22%, p < 0.0001) and have a history of previous cesarean sections (24.8% vs. 18.2%, p = 0.045). Differences in pre-gestational diabetes (7.1% vs. 4.1%, p = 0.086) and hypertension (12% vs. 8.4%, p = 0.125) .The BS group was less likely to develop PIH (aOR–0.39, 95%CI–0.21–0.72) and GDM( aOR–0.40, 95%CI–0.23–0.70) when compared to the control group. When comparing the PCOS with and without BS; differences in gestational hypertension(95%CI–0.22–1.30), preeclampsia(95%CI–0.19–1.15), spontaneous vaginal delivery (95%CI 0.58–1.3), operative vaginal delivery (95%CI 0.34–1.8), Cesarean section (95%CI 0.79–1.79), post partum hemorrhage (95%CI–0.12–1.94), transfusion (95%CI–0.1–5.22), preterm delivery (95%CI–0.56–1.75) and maternal infection (95%CI–0.27–2.07) were similar. Regarding neonatal outcomes of PCOS with and without BS: small for gestational age babies (95%CI–0.26–2.68), and congenital anomalies (95%CI–0.09–4.52) were similar. Limitations, reasons for caution Limitations of our study include its retrospective design. Information regarding the time interval between the surgical intervention and pregnancy wasn’t available. Nor was information on the type of gastric bypass performed. Wider implications of the findings: Our study demonstrated an association between bariatric surgery in the setting of PCOS patients and a reduced risk of GDM and PIH. Although no differences were noted in other delivery and neonatal outcomes, data was not compared to a group of strictly obese PCOS controls. Trial registration number Not applicable

Pregnancy outcome of patients with gestational diabetes mellitus following bariatric surgery

2006 ◽  
Vol 194 (2) ◽  
pp. 431-435 ◽  
Author(s):  
Eyal Sheiner ◽  
Tehillah S. Menes ◽  
Daniel Silverberg ◽  
Jacques S. Abramowicz ◽  
Isaac Levy ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Bariatric Surgery ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnancy Outcome

scholarly journals Diagnosing gestational diabetes mellitus in women following bariatric surgery: A national survey of lead diabetes midwives

2016 ◽  
Vol 24 (6) ◽  
pp. 434-438 ◽  
Author(s):  
Martin Whyte ◽  
Roisin Johnson ◽  
Deborah Cooke ◽  
Kathryn Hart ◽  
Marie McCormack ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Bariatric Surgery ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
National Survey

scholarly journals Type 2 diabetes, bariatric surgery and the risk of subsequent gestational diabetes

2011 ◽  
Vol 4 (4) ◽  
pp. 171-173 ◽  
Author(s):  
S Steven ◽  
S Woodcock ◽  
P K Small ◽  
R Taylor
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Gestational Diabetes ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Maternal Blood ◽  
Subsequent Pregnancy ◽  
Glucose Levels

Women with pre-existing abnormal glucose regulation are certain to develop gestational diabetes in pregnancy and pre-gestational type 2 diabetes will become more difficult to control. However, an increasing number of women with type 2 diabetes have had bariatric surgery. In this group, the effect of pregnancy on glucose metabolism is unknown. We report two women with type 2 diabetes who underwent laparoscopic gastric bypass surgery with normalization of plasma glucose levels. During subsequent pregnancy, maternal blood glucose levels remained completely normal throughout. This is remarkable given the predisposition to abnormal glucose tolerance and the ongoing obesity, in the face of the insulin resistance of pregnancy. Women with prior type 2 diabetes reversed by gastric bypass surgery are not at high risk for gestational diabetes.

Reduced Incidence of Gestational Diabetes with Bariatric Surgery

2010 ◽  
Vol 211 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Anne E. Burke ◽  
Wendy L. Bennett ◽  
Roxanne M. Jamshidi ◽  
Marta M. Gilson ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gestational Diabetes

scholarly journals Screening and Management of Gestational Diabetes Mellitus after Bariatric Surgery

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1479 ◽  
Author(s):  
Katrien Benhalima ◽  
Caro Minschart ◽  
Dries Ceulemans ◽  
Annick Bogaerts ◽  
Bart Van Der Schueren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Bariatric Surgery ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Screening Tests ◽  
Oral Glucose ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Increased Risk

Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. This is partly due to the increasing prevalence of obesity in women of childbearing age. Since bariatric surgery is currently the most successful way to achieve maintained weight loss, increasing numbers of obese women of childbearing age receive bariatric surgery. Bariatric surgery performed before pregnancy significantly reduces the risk to develop GDM but the risk is generally still higher compared to normal weight pregnant women. Women after bariatric surgery therefore still require screening for GDM. However, screening for GDM is challenging in pregnant women after bariatric surgery. The standard screening tests such as an oral glucose tolerance test are often not well tolerated and wide variations in glucose excursions make the diagnosis difficult. Capillary blood glucose measurements may currently be the most acceptable alternative for screening in pregnancy after bariatric surgery. In addition, pregnant women after bariatric surgery have an increased risk for small neonates and need careful nutritional and foetal monitoring. In this review, we address the risk to develop GDM after bariatric surgery, the challenges to screen for GDM and the management of women with GDM after bariatric surgery.

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