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

Gülen Yerlikaya-Schatten,Michael Feichtinger,Christian S Göbl,Peter Husslein,Evelyn A Huhn,Kinga Chalubinski,Tina Stopp,Christian Schatten,Wolfgang Eppel

doi:10.1007/s11695-019-04115-9

Gülen Yerlikaya-Schatten, Michael Feichtinger + Show 7 more

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https://doi.org/10.1007/s11695-019-04115-9

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Abstract

PurposeRecent 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.MethodsRetrospective 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.ResultsFSCTT 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.ConclusionIn 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.

Highlights

The number of obese women in childbearing age undergoing bariatric surgery has risen significantly within the past years [1]
fetal subcutaneous adipose tissue thickness (FSCTT) was significantly lower in fetuses of women after gastric bypass surgery (GB) as compared to body mass index (BMI)-matched controls in the second and third trimester of gestation
Longitudinal analysis revealed significant differences in mean FSCTT trajectories between the groups: FSCTT in offspring of GB mothers increased by 0.37 mm per 8 weeks of gestation, whereas FSCTT in offspring of BMI-matched controls increased by 2.08 mm resulting in a significant group per time interaction (b = 1.71 mm, 95%CI 1.39–2.03 mm, p < 0.001, Fig. 2a)

Summary

Introduction

The number of obese women in childbearing age undergoing bariatric surgery has risen significantly within the past years [1]. Basel, Switzerland 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]. A longitudinal evaluation of FSCTT in pregnancies after bariatric surgery has not been assessed so far

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