Longitudinal metabolic and gut bacterial profiling of pregnant women with previous bariatric surgery

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>Due to the global increase in obesity rates and success of bariatric surgery in weight reduction, an increasing number of women now present pregnant with a previous bariatric procedure. This study investigates the extent of bariatric-associated metabolic and gut microbial alterations during pregnancy and their impact on fetal development.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A parallel metabonomic (molecular phenotyping based on proton nuclear magnetic resonance spectroscopy) and gut bacterial (16S ribosomal RNA gene amplicon sequencing) profiling approach was used to determine maternal longitudinal phenotypes associated with malabsorptive/mixed (n=25) or restrictive (n=16) procedures, compared with women with similar early pregnancy body mass index but without bariatric surgery (n=70). Metabolic profiles of offspring at birth were also analysed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Previous malabsorptive, but not restrictive, procedures induced significant changes in maternal metabolic pathways involving branched-chain and aromatic amino acids with decreased circulation of leucine, isoleucine and isobutyrate, increased excretion of microbial-associated metabolites of protein putrefaction (phenylacetlyglutamine, <jats:italic>p-</jats:italic>cresol sulfate, indoxyl sulfate and <jats:italic>p-</jats:italic>hydroxyphenylacetate), and a shift in the gut microbiota. The urinary concentration of phenylacetylglutamine was significantly elevated in malabsorptive patients relative to controls (p=0.001) and was also elevated in urine of neonates born from these mothers (p=0.021). Furthermore, the maternal metabolic changes induced by malabsorptive surgery were associated with reduced maternal insulin resistance and fetal/birth weight.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Metabolism is altered in pregnant women with a previous malabsorptive bariatric surgery. These alterations may be beneficial for maternal outcomes, but the effect of elevated levels of phenolic and indolic compounds on fetal and infant health should be investigated further.</jats:p></jats:sec>

Roux-en-Y gastric bypass surgery in Zucker rats induces bacterial and systemic metabolic changes independent of caloric restriction-induced weight loss

“…2 Roux-en-Y Gastric Bypass (RYGB) is amongst the most commonly performed bariatric procedures and has been shown to increase circulating anorexigenic and glucoregulatory gut hormone levels (e.g., glucagon-like peptide-1 (GLP-1) and peptide YY (PYY)), as well as to induce profound systemic metabolic and the gut microbial changes. 3,4 An increase in the relative bacterial abundance of Gammaproteobacteria and Verrucomicrobia in feces has consistently been reported in both human and animal models post RYGB. [4][5][6] These gut bacterial changes in the RYGBoperated patients are persistent for up to 9 years post-operatively, and are considered to regulate host metabolism and fat mass.…”

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

“…Furthermore, these changes were associated with a shift in the intestinal microbiome. Data from this research also suggest an association with reduced maternal insulin resistance, as well as the risk of delivery of an SGA infant [ 106 ]…”

“…Evidence from metabolomics research and intestinal bacterial profiling in a pregnant population that underwent bariatric surgery is currently very limited. Very recently, a small study in pregnant women after bariatric surgery (25 with RYBG and eight with SG), showed that the subgroup with RYBG had significantly lower serum concentrations of branched-chain amino acids (leucine and isoleucine) and branched-chain fatty acids (isobutyrate) in the third trimester of pregnancy [ 106 ]. Furthermore, these changes were associated with a shift in the intestinal microbiome.…”

Maternal Roux-en-Y gastric bypass surgery reduces lipid deposition and increases UCP1 expression in the brown adipose tissue of male offspring

“…The BS promote rapid weight loss and correct metabolic abnormalities common in obesity 13 , such as changing the molecular pathways involved in inflammatory and immunological response, cell differentiation, oxidative stress regulation 45 , significantly reduces visceral WAT content, restores insulin sensitivity and normalizes glucose and lipid homeostasis 46 . In addition, BS changes serum concentrations of branched-chain amino acids and fatty acids, urinary concentrations of microbial co-metabolites and components of the gut microbiota, and all these changes may have effects on pregnancy 47 . Thus, maternal BS could be a reprogramming strategy to reverse adverse metabolic effects of maternal obesity in descendants.…”