Abstract
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.
Highlights
The prevalence of obesity continues to rise worldwide: in 2015 it was estimated to be 5% among children and 12% among adults
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)
We identified nine observational studies that report on glycemic levels during a pregnancy after 4b.a1r.iaCthraicrascuterrgiesrtiycs(Toaf bGlleu2co).seSeHvoemnesotsutadsiiessinhaPdreagnsatundcyyApfotperuBlaatriioantriocfSleusrsgetrhyan 50 participants
Summary
The prevalence of obesity continues to rise worldwide: in 2015 it was estimated to be 5% among children and 12% among adults. Median age at the time of operation was 42 years [7] This confirms other reports that show that more than 50% of bariatric surgeries are performed in women of childbearing age [8]. Pregnancies in women with a history of bariatric surgery are becoming increasingly prevalent. Knowledge about glucose homeostasis in these pregnancies could elucidate some of the mechanisms behind these outcomes. 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). 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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