Oral Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Roux-en-Y gastric bypass increases time spent in hypoglycemia during pregnancy (#18)

Louise Laage LLS Stentebjerg 1 2 , Lene Ring LRM Madsen 3 4 5 , Rene Klinkby RKS Støving 1 6 , Lise Lotte LLA Andersen 1 7 , Christina Anne CAV Vinter 1 2 7 , Claus Bogh CBJ Juhl 2 8 9 , Dorte Møller DMJ Jensen 1 2 7
  1. Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  2. Steno Diabetes Center Odense, Odense Universitetshospital, Odense C, FUNEN, Denmark
  3. Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
  4. Department of Internal Medicine, Regional Hospital West Jutland, Herning, Denmark
  5. Danish Diabetes Academy, University Hospital Denmark, Odense, Denmark
  6. Department of Endrocrinology, Odense University Hospital, Odense, Denmark
  7. Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
  8. Department of Endocrinology, Hospital of South West Jutland, Esbjerg, Denmark
  9. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

Objective

Roux-en-Y gastric bypass (RYGB) and pregnancy markedly alter glucose metabolism, but evidence on glucose metabolism in pregnancy following RYGB is limited. Thus, the aims of the Bariatric surgery And consequences for Mother and Baby In pregnancy (BAMBI) study  were to investigate interstitial glucose (IG) profiles during pregnancy, risk factors associated with hypoglycemia, and the association between fetal growth and hypoglycemia in pregnant women previously treated with RYGB compared to matched controls.

Research Design and Methods

In total, 23 pregnant women with RYGB and 23 BMI- and parity-matched pregnant controls were prospectively studied with continuous glucose monitoring (CGM) in the 1st, 2nd and 3rd trimester, as well as 4–6 weeks postpartum. Time in range (TIR) was defined as time with IG of 3.5–7.8 mmol/L.

Results

Pregnancies occurred 30 months (IQR: 15–98) following RYGB, which induced a reduction in BMI from 45 kg/m2 (IQR: 42–54) pre-surgery to 32 kg/m2 (IQR: 27–39) pre-pregnancy. TIR was significantly lower throughout pregnancy and postpartum for the RYGB group compared to controls (87.3–89.5% vs. 93.3–96.1%, p<0.01), due to an increase in both time above range and time below range (TBR)(Figure 1). Accordingly, the coefficient of variation was significantly higher in the RYGB group as a result of an increased diurnal glycemic variability. The women treated with RYGB ran significantly lower nocturnal IG (Figure 2), and the mean nocturnal IG significantly decreased as pregnancy advanced for women treated with RYGB. In the postpartum period, the median of mean nocturnal IG increased to a level higher than that of the 1st trimester. In the course of pregnancy, 48% of the women with RYGB spent increased TBR with highest mean TBR in mid-pregnancy (3.1%, SD 4.5). Women with increased time in hypoglycemia had longer surgery-to-conception interval, lower nadir weight, and greater weight loss following RYGB. Finally, women giving birth to small-for-gestational age neonates tended to spend more time in TBR.

Conclusions

Women with RYGB are more exposed to hypoglycemia during pregnancy compared to matched controls, especially in mid- and late pregnancy. Longer surgery-to-conception interval, a lower nadir weight, and a greater weight loss may be warning signs of hypoglycemia in pregnancy. Further research should investigate whether hypoglycemia during pregnancy in women with RYGB is associated with fetal growth restriction.

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