Hypoglycemia Is Common During Pregnancy After Bariatric Surgery

Hypoglycemia is common during oral glucose tolerance testing (OGTT) among pregnant women who previously underwent bariatric surgery, according to a recent study.

Previous studies have demonstrated that hypoglycemia during an oral glucose tolerance test (OGTT) occurs in a considerable portion of bariatric surgery recipients. However, little is known regarding its incidence among pregnant recipients with possible gestational diabetes.
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To explore this further, the researchers evaluated OGTT results and pregnancy outcomes among 119 pregnant women who underwent either laparoscopic sleeve gastrectomy (LSG; n=55), laparoscopic adjustable gastric banding (LAGB; n=34), or laparoscopic Roux-en-Y gastric bypass (LRYGB; n=30) prior to pregnancy.

Hypoglycemia was defined as having glucose levels below 55 mg/dL during an OGTT.

Results indicated that 59 (49.6%) patients had hypoglycemia, with nadir plasma glucose levels occurring 2 hours after glucose ingestion in 25 (42.4%) patients and after 3 hours in 34 (57.6%) patients (median value: 47 mg/dL). Ultimately, the researchers observed that that the risk for hypoglycemia was higher in LRYGB recipients (83.3%) compared with LSG (54.5%) and LAGB recipients (11.8%).

The researchers found that time from surgery to conception had been significantly shorter among women with hypoglycemia during OGTT (median 711 days vs 1246 days). They also noted that patients with hypoglycemia had lower rates of gestational diabetes, but higher proportions of low birth weight and small-for-gestational age infants vs patients without hypoglycemia.

“Since hypoglycemia is common during OGTT among [post-bariatric surgery] parturients, other diagnostic methods should be considered in this setting,” the researchers concluded. “The association found between hypoglycemia and poor fetal growth warrants investigation as to whether interventions to prevent hypoglycemia will improve fetal outcome.”

—Christina Vogt

Reference:

Rottenstreich A, Elazary R, Ezra Y, Kleinstern G, Beglaibter N, Elchalal U. Hypoglycemia during oral glucose tolerance test among post-bariatric surgery pregnant patients: incidence and perinatal significance [Published online December 8, 2017]. Surg Obes Rel Dis.  http://dx.doi.org/10.1016/j.soard.2017.11.031.