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

Feichtinger, Michael; Falcone, Veronica; Schoenleitner, Theresa; Stopp, Tina; Husslein, Peter; Eppel, Wolfgang; Chalubinski, Kinga; Göbl, Christian

doi:10.1055/a-0651-0424

Cited by 12 publications

(7 citation statements)

References 32 publications

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“…The association between GB and SGA fetuses has been previously reported and discussed [4,6]. In addition to these observations, we recently observed markedly decreasing growth curves from the beginning of the second trimester until the end of pregnancy with the largest effect on the abdominal circumference [8]. While the mechanisms beyond these findings are not clarified yet, we assume that development of SGA offspring may be related to metabolic as well as micronutrient deficiencies, which commonly occurred in women after bariatric surgery and especially during pregnancy [6,13].…”

Section: Discussionsupporting

confidence: 77%

“…Details of the study design are reported elsewhere [8]. In short, we retrospectively included 82 singleton pregnancies, 41 women after gastric bypass surgery (GB) and 41 BMI and agematched controls (BMIM), treated at our department between January 2007 and January 2016.…”

Section: Methodsmentioning

confidence: 99%

“…Although bariatric surgery is the most effective treatment for morbid obesity in diabetic patients [2,3], recent studies showed that women after surgery are at higher risk of perinatal complications such as preterm birth or delivering small-forgestational (SGA) infants [4][5][6][7]. In this context, we recently demonstrated a continuous decline in fetal growth throughout pregnancy after gastric bypass surgery, starting at the early second trimester [8]. Although the pathophysiologic mechanism beyond this observation remains unclear, it is believed that fetal growth delay is rather caused by nutrient deficiency and postprandial hypoglycemia (due to dumping syndrome) than by growth restriction due to placenta etiology or preeclampsia [5,9].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…The timing of growth retardation in these fetuses is a topic of debate. A 2017 Austrian study found more pronounced hypoglycemia during an OGTT to be associated with reduced fetal abdominal circumference during the second trimester of pregnancy [ 62 ]. A 2020 prospective longitudinal study from the UK showed reduced fetal growth velocity starting in the third trimester, when compared to non-operated women with similar pre-pregnancy BMI [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

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

Deleus

Schueren

Devlieger

et al. 2020

JCM

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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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“…In this context, we demonstrated in previous studies a continuous decline in fetal growth throughout singleton pregnancy after bariatric surgery [5] and second a markedly decline of fetal subcutaneous adipose tissue thickness (FSCTT) of fetuses of mothers with a history of bariatric surgery [6]. Although the pathophysiological mechanisms remain unclear, it is believed that fetal growth restriction and low FSCTT are more likely caused by nutrient deficiency and by multifactorial genesis with altered metabolism as the most important factor, rather than by growth restriction due to placenta etiology or preeclampsia (PE) [7].…”

Section: Introductionmentioning

confidence: 94%

Fetal Growth and Adipose Fat Tissue Trajectories in Twin Pregnancies after Gastric Bypass Surgery

et al. 2021

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Introduction: Previous studies demonstrated a continues decline in fetal growth throughout singleton pregnancy after bariatric surgery. However, intrauterine growth in twin pregnancy is subjected to further underlying processes. This study was to investigate the longitudinal assessment of fetal biometry and abdominal fat thickness of twin pregnancies conceived after gastric bypass surgery and compare them to BMI-matched and obese controls. Materials and methods: We retrospectively assessed ultrasound data of 30 women with dichorionic-diamniotic twin pregnancy (11 women after gastric bypass surgery, 9 obese mothers with pregestational BMI ≥ 30 kg/m² and 10 BMI and age matched controls). We assessed fetal growth parameters including fetal subcutaneous adipose tissue thickness (FSCTT) as well as newborn biometry after delivery. Patient characteristics were obtained from the medical records. Results: The rise in FSCTT curves was markedly slower in twin offspring of women with history of gastric bypass as compared to offspring of obese mothers and offspring of BMI matched controls. Hence, FSCTT was significantly decreased in gastric bypass offspring as compared to both control groups at 34 weeks of gestation. Also, growth curves of abdominal circumference were decreased in offspring of gastric bypass patients as compared to obese mothers. Infants of mothers with history of gastric bypass showed significantly lower birth weight percentiles compared to newborns of obese mothers (27.2 vs 48.8 pct, p=0.025). There was no significant difference in inter twin birth weight difference between offspring of gastric bypass (median: 9.9%, IQR: 6.5 to 20.0) vs. obese (median: 14.6%, IQR: 8.2 to 21.6) and BMI matched controls (median: 9.0%, IQR: 6.3 to 12.6, p=0.714). Conclusions: In summary, intrauterine growth delay in twin pregnancies after GB is assumed to be a multifactorial event with altered metabolism as the most important factor. However, special attention must be paid to the particularity of twin pregnancies as they seem to be subject to other additional mechanism.

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

Cited by 12 publications

References 32 publications

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

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

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

Fetal Growth and Adipose Fat Tissue Trajectories in Twin Pregnancies after Gastric Bypass Surgery

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