Endocrine Abstracts

Introduction: Post-bariatric hypoglycaemia (PBH) is an increasingly recognised complication presenting in patients post-bariatric surgery. With >80% of patients who underwent bariatric surgery between 2020 and 2024 being female, and the majority of patients being of childbearing age, it is fundamental to understand potential risks of this complication during pregnancy. PBH is diagnosed with confirmation of Whipple’s triad, and usually presents 2-4 hours after the ingestion of food. Medical management of PBH is not recommended in pregnancy, thus effective treatment options need to be explored.

Case Series: We present six patients diagnosed with PBH during pregnancy. 4/6 patients had sleeve gastrectomy and 2/6 Roux-en-Y gastric bypass. Duration between bariatric surgery and pregnancy varied between 8 and 44 months. Multidisciplinary team approach was adopted for all patients, involving specialist dieticians, obstetricians, diabetic midwives and diabetologists. Mainstay management was dietary modification. Continuous glucose monitoring was utilised in addition in 4/6 patients for early correction of hypoglycaemia. 4/6 cases had greatly improved symptoms with dietary modification alone, however 2/6 cases had persistent hypoglycaemic severity and frequency. All patients had successful neonate delivery, with no complications noted. Post pregnancy, one case continues to suffer with severe hypoglycaemia resulting in multiple hospitalisations, and after multiple failed attempts with medical management, is awaiting thoracic outlet reduction surgery.

Discussion: PBH is an increasing complication recognised in pregnancy. It holds significant risk to both foetus and mother, including small for gestational age, intrauterine growth restriction, reduced quality of life and increased risk of mortality. Management during pregnancy is dietary modification alone. No randomised controlled trials have been conducted on safety and efficacy of medical management in pregnancy and no national/international guidelines exist on management of PBH in pregnancy. Both are urgently needed given the increasing prevalence of this significant complication.