Endocrine Abstracts

Background: Bariatric surgery (BS) is a well-documented treatment targeting weight loss excess. There is little evidence on the impact of BS on antenatal glycaemic control. We present four cases of pregnancy post-BS, reviewed in the joint antenatal clinic, who experienced various degrees of hypoglycaemia during pregnancy.

Case presentations: Four pregnant women (cases A–D, aged 25–36-years-old, 3–8years post-BS) were referred for postprandial hypoglycaemia, presenting with sweating, palpitations, dizziness and loss of consciousness. Oral glucose tolerance tests (OGTT) were performed in cases A,B,C (gestational age 28–30w) at the discretion of the obstetrics team; all three women experienced postprandial hypoglycaemia with the OGTT (blood glucose (BG) at 2hr: 1.8–2.6mmol/l). The women experienced variable degrees of hypoglycaemia during pregnancy, especially pronounced in case A secondary to co-existent hyperemesis gravidarum, and case C due to preconception hypoglycaemia unawareness. Case D fortunately was advised for BG-monitoring only. No delivery was uneventful: case A, induced at 38w, required intravenous glucose-supplementation during delivery; case B underwent emergency caesarean section (CS) at 39w due to failure to progress, under oral glucose-supplementation; case C underwent emergency CS at 38+3w, due to reduction in foetal growth velocity (estimated birth weight (BW) 69→53 centile) and required intravenous glucose-supplementation throughout admission until postpartum; case D underwent elective CS at 38w, with no glycaemic imbalance during delivery. All newborns were healthy, and babies A,B,D were of low BW (centiles: 15.7, 13.7, 13.7). Post-delivery there has been significant improvement in hypoglycaemic episodes.

Conclusions: Whilst Endocrinologists recommend avoiding OGTTs in women with BS, clear guidelines need to be developed for the multidisciplinary antenatal teams to ensure OGTTs are avoided, as well as guiding management of hypoglycaemia in pregnancy and during delivery. Future studies should investigate the role of BS type and impact on hypoglycaemia in pregnancy.