Glucose Profiles in Pregnant Women After a Gastric Bypass

Bonis, Camille; Lorenzini, F.; Bertrand, Monelle; Parant, Olivier; Gourdy, Pierre; Cazals, L.; Ritz, Patrick; Hanaire, H.

doi:10.1007/s11695-016-2061-z

Cited by 36 publications

(27 citation statements)

References 33 publications

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“…This effect was increased in the RYGB group during pregnancy (as an exaggerated insulin release was observed only during the OGTT and not during the IVGTT) and likely contributed to the high glycaemic variability seen after oral glucose administration. In line with our results, a recent study that used continuous subcutaneous glucose monitoring to evaluate glucose profiles in 35 bariatric pregnancies, suggested that abnormal glucose variability occurred in real-life conditions [35]. It is also worth noting that we found an exaggerated glucagon release immediately after glucose ingestion in the RYGB group.…”

Section: Discussionsupporting

confidence: 91%

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: Discussionsupporting

confidence: 91%

Assessment of glucose regulation in pregnancy after gastric bypass surgery

et al. 2017

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“…While a causal relationship between glycemic alterations and fetal development is obvious, we suggest that more detailed longitudinal examinations of glucose metabolism during pregnancy after GB would be essential to clarify this topic. Only one recent study using continuous subcutaneous glucose monitoring (CGM) in pregnant women with history of GB reported elevated postprandial glucose peaks followed by a rapid fall until 120 min after ingestion, suggesting considerable high amount of glucose variability in real-life conditions [20]. However, a detailed analysis of possible associations between glucose metabolism and fetal development was not provided in this study.…”

Section: Discussionmentioning

confidence: 86%

Trajectories of Fetal Adipose Tissue Thickness in Pregnancies After Gastric Bypass Surgery

et al. 2019

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Purpose Recent studies showed that women after surgery are at higher risk of delivering small-for-gestational infants. Thus, this study aims to investigate longitudinal changes of fetal subcutaneous adipose tissue thickness (FSCTT) of fetuses conceived after gastric bypass surgery as compared to BMI-matched controls. Methods Retrospective cohort study measuring ultrasound-derived longitudinal trajectories of abdominal FSCTT in 41 singleton pregnancies after gastric bypass surgery compared to 41 BMI-matched controls and 64 obese mothers.Results FSCTT was significantly lower in fetuses of women after GB as compared to BMI-matched controls in the second (mean difference 1.38 mm, p < 0.001) and third trimester of gestation (mean difference 3.37 mm, p < 0.001). Longitudinal analysis revealed significant differences in mean FSCTT trajectories between offspring's in GB mothers, BMI-matched, or obese controls. The ratio of FSCTT and abdominal circumference remained constant in the BMI-matched control group whereas it significantly decreased in fetuses of women after GB. Despite remarkable differences were observed in longitudinally assessed FSCTT, further analyses in the GB subgroup revealed that FSCTT were not influenced by OGTT mean or 120 min glucose values, biochemically hypoglycemia, time since bariatric surgery, or weight loss since surgery. Conclusion In fetuses of mothers with history of bariatric surgery, abdominal FSCTT was markedly reduced. While the underlying mechanisms are not fully understood, a multifactorial genesis including nutritional deficiencies and altered metabolism after bariatric surgery is assumed.

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“…However, while those patients only had relatively lower glucose levels compared to controls, more than 50 % of pregnant gastric bypass women present with pronounced hypoglycemia in the OGTT [6,19]. Moreover, continuous glucose monitoring during pregnancy revealed that RYGB patients spend over 13 % of their time with blood glucose levels below 60 mg/dl [20]. A possible relation between fetal growth and glycemic dysregulation in mothers after GB surgery was also underlined by our previous study where glucose nadir and insulin response during an OGTT were associated with lower birth weight percentiles as well [17].…”

Section: Discussionmentioning

confidence: 98%

Intrauterine Fetal Growth Delay During Late Pregnancy After Maternal Gastric Bypass Surgery

et al. 2018

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Purpose To investigate intrauterine fetal growth development and birth anthropometry of fetuses conceived after maternal gastric bypass surgery. Materials and Methods Longitudinal cohort study describing longitudinal growth estimated by ultrasound on 43 singleton pregnancies after gastric bypass compared to 43 BMI-matched controls. Results In fetuses after maternal gastric bypass surgery, growth percentiles decreased markedly from the beginning of the second trimester until the end of the third trimester (decrease of 3.1 fetal abdomen circumference percentiles (95 %CI 0.9–5.3, p = 0.007) per four gestational weeks). While in the second trimester, fetal anthropometric measures did not differ between the groups, the mean abdomen circumference percentiles appeared significantly smaller during the third trimester in offspring of mothers after gastric bypass (mean difference 25.1 percentiles, p < 0.001). Similar tendencies have been observed in estimated fetal weight resulting in significantly more SGA offspring at delivery in the gastric bypass group. In children born after maternal gastric bypass surgery, weight percentiles (32.12th vs. 55.86th percentile, p < 0.001) as well as placental weight (525.2 g vs. 635.7 g, p < 0.001) were significantly reduced compared to controls. Conclusion In fetuses conceived after maternal gastric bypass, intrauterine fetal growth distinctively declined in the second and third trimester, most prominently observed in fetal abdomen circumferences. Birth weight and placental weight at birth was significantly lower compared to BMI-matched controls, possibly due to altered maternal metabolic factors and comparable to mothers experiencing chronic hunger episodes.

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Glucose Profiles in Pregnant Women After a Gastric Bypass

Cited by 36 publications

References 33 publications

Assessment of glucose regulation in pregnancy after gastric bypass surgery

Assessment of glucose regulation in pregnancy after gastric bypass surgery

Trajectories of Fetal Adipose Tissue Thickness in Pregnancies After Gastric Bypass Surgery

Intrauterine Fetal Growth Delay During Late Pregnancy After Maternal Gastric Bypass Surgery

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