Abstract
Aims/hypothesisRoux-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.MethodsSixty-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.ResultsWe 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 × 10−4 min−1 [pmol/l]−1 [95% CI 0.104, 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/interpretationPregnancies 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.
Highlights
The obesity epidemic has become a major healthcare problem in industrialised and developing countries and is strongly associated with reduced health-related quality of life [1] and an increased risk for metabolic and cardiovascular disorders [2]
Electronic supplementary material The online version of this article contains peer-reviewed but unedited supplementary material, which is available to authorised users. 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 and disposition index in pregnancies after Roux-en-Y gastric bypass (RYGB) when compared with obese control women
Summary
The obesity epidemic has become a major healthcare problem in industrialised and developing countries and is strongly associated with reduced health-related quality of life [1] and an increased risk for metabolic and cardiovascular disorders [2]. An increase in the prevalence of obesity is already being seen in younger populations [7], meaning that weight-loss surgery is emerging as a treatment option even in women of reproductive age. Studies in non-pregnant women suggest that gastric bypass surgery is characterised by an exaggerated postprandial rise in blood glucose followed by hyperinsulinaemic hypoglycaemia, despite long-term improvements in type 2 diabetes onset or management [15]. These effects might occur during gestation, with possible implications for pregnancy and GDM screening. Data from detailed examination of glucose metabolism in pregnancies following RYGB surgery are currently not available
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