Pregnancy after bariatric surgery: screening for gestational diabetes

Adam, Safwaan; Ammori, Basil J.; Soran, Handrean; Syed, Akheel A.

doi:10.1136/bmj.j533

Cited by 31 publications

(40 citation statements)

References 5 publications

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“…Pregnancy should be avoided within 2 years after bariatric surgery and young fertile women should use safe birth control (103). Performing OGTT after bariatric surgery can trigger dumping syndromes and is generally not recommended (104). OGTT-induced dumping syndrome can lead to inaccurate results of the OGTT and the risk of reactive hypoglycemia was 55% in previous studies (105).…”

Section: Bariatric Surgery Gdm and Ogttmentioning

confidence: 99%

“…Instead, HbA1c can be measured at the first antenatal visit to exclude pre-existing diabetes, but later in pregnancy there are no data to support use of HbA1c. Instead, fasting, pre-and postprandial capillary blood glucose measurements are recommended to screen for GDM in pregnant women with previous bariatric surgery (104). The diagnostic or intervention thresholds for capillary blood glucose were >5.3 mmol/L before meals, >7.8 mmol/L 1 h after meals and >6.4 mmol/L 2 hours after meals according to National Institute for Health and Care Excellence (NICE) (https://www.nice.org.uk/guidance/ng3/).…”

Section: Bariatric Surgery Gdm and Ogttmentioning

confidence: 99%

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Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Andersen

Glintborg

2018

European Journal of Endocrinology

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Polycystic ovary syndrome (PCOS) is common in premenopausal women. The majority of women with PCOS have insulin resistance and the risk of type 2 diabetes mellitus (T2D) is higher in women with PCOS compared to controls. In non-pregnant women with PCOS, glycemic status may be assessed by oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) or HbA1c. OGTT has been reckoned gold standard test for diagnosing T2D, but OGTT is rarely used for diagnostic purpose in other non-pregnant individuals at risk of T2D, apart from PCOS. OGTT has questionable reproducibility, and high sensitivity of the 2-h glucose value is at the expense of relatively low specificity, especially regarding impaired glucose tolerance (IGT). Furthermore, lean women with PCOS are rarely diagnosed with T2D and only few percent of normal-weight women have prediabetes. Glycemic status is necessary at diagnosis and during follow-up of PCOS, especially in women with high risk of T2D (obesity, previous gestational diabetes (GDM)). We suggest that OGTT should be used in the same situations in PCOS as in other patient groups at risk of T2D. OGTT is indicated for diagnosing GDM; however, OGTT during pregnancy may not be indicated in lean women with PCOS without other risk factors for GDM.

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Section: Bariatric Surgery Gdm and Ogttmentioning

confidence: 99%

Section: Bariatric Surgery Gdm and Ogttmentioning

confidence: 99%

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Andersen

Glintborg

2018

European Journal of Endocrinology

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“…Screening for Gestational Complications: Screening for hypertension and GDM should be undertaken; however, consideration needs to be given to the screening modality [132]. Rapid absorption of the high glucose load used in the conventional oral glucose tolerance test (OGTT) can precipitate dumping syndrome and hypoglycaemia [102].…”

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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“…Im Rahmen einer interdisziplinären Betreuung ist auf eine ausreichende Zufuhr von Vitaminen (Vitamin B12, β-Carotin, Vitamin D, Folsäure), Spurenelementen (Eisen, Kalzium) und Eiweiß zu achten (> 60 g/d) [44]. Ein oraler Glucosetoleranztest ist nach bariatrischer Operation kontraindiziert, da das Risiko eine Dumping-Syndroms mit schweren hypoglykämischen Reaktion erhöht ist [49]. Stattdessen empfiehlt sich ein regelmäßiges Monitoring der Blutzuckerwerte.…”

Section: Praktische Empfehlungen Zur Betreuung Adipöser Frauen In Derunclassified

“…Stattdessen empfiehlt sich ein regelmäßiges Monitoring der Blutzuckerwerte. Wiederholte Überschreitungen des Blutzuckers nüchtern > 5,3 mmol/l oder eine Stunde postprandial > 7,8 mmol/l sollten als Grundlage hinsichtlich der Diagnose beziehungsweise Therapie eines Gestationsdiabetes Anwendung finden [49].…”

Section: Praktische Empfehlungen Zur Betreuung Adipöser Frauen In Derunclassified

Schwangerschaft und Geburt bei Adipositas

Stubert

2019

Adipositas - Ursachen, Folgeerkrankungen, Therapie

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ZusammenfassungEine Adipositas in der Schwangerschaft findet sich bei 10 bis 18 % aller Frauen in Deutschland. Sie trägt maßgeblich zu einer erhöhten Morbidität bei und wirkt sich sowohl auf das mütterliche als auch fetale Schwangerschaftsoutcome ungünstig aus. Besonders bei hochgradiger Adipositas ist eine intensive Überwachung der Schwangerschaft notwendig. Die Schwangerschaft begleitende Ernährungs- und Trainingsinterventionen können zwar dazu beitragen, die intragravide Gewichtszunahme zu reduzieren, wirken sich aber nur unwesentlich auf geburtshilflich relevante Risiken wie Gestationsdiabetes, hypertensive Schwangerschaftserkrankungen oder eine fetale Makrosomie aus. Umso bedeutsamer ist die Gewichtsoptimierung im Vorfeld einer geplanten Schwangerschaft. Bei Frauen mit Zustand nach bariatrischer Operation sind besondere Risikoaspekte zu berücksichtigen.

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Pregnancy after bariatric surgery: screening for gestational diabetes

Abstract: Safer alternatives are needed to traditional test

Cited by 31 publications

References 5 publications

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

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

Schwangerschaft und Geburt bei Adipositas

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