Endocrine Abstracts

Worsening of retinopathy after bariatric surgery has been reported¹ and there has been a recent small cohort stating the same², however to our knowledge this is the first report of occurrence in pregnancy post bariatric surgery with a previous diagnosis of type 2 diabetes mellitus.

A 33-year-old female presented to the joint antenatal clinic at 28/40 gestation for a GTT.

She had undergone a Roux en y gastric bypass (01/2012) 11 months prior to this pregnancy so GTT was avoided to prevent dumping. BM monitoring was commenced. The referring midwife at booking stated she was told that her diabetes had ‘gone away’.

She had a history of type 2 diabetes mellitus since 2005, retinopathy and hypertension. Her BMI was 55 with a weight of 145 kg pre-surgery (she had a 10 kg weight loss with Liraglutide). Post-surgery her weight was 102 kg giving her a booking BMI of 36. Diabetic medications were discontinued. BMs were out of pregnancy targets at 28 weeks and metformin commenced. Given her past history urgent retinal examination was requested, revealing proliferative retinopathy and she underwent urgent pan-retinal laser. Particular attention was given to her micronutrients requirements. Her elective section was uneventful.

We know from the Swedish NHS birth register study that women are at an increased risk of pre-term and small for gestational age births post-surgery³. In addition a review of the key results of the Swedish Obese Subjects Trial in which diabetes prevention and remission were secondary end points showed after 2 years, 72% of patients with T2DM at baseline were in remission in the post-surgical group, however 50% relapsed after 10 years⁴. This case highlights the need to ensure appropriate education regarding the metabolic and fertility sequelae after surgery. Currently there is no UK guidance surrounding GDM screening post bariatric surgery, these may need to be patient and procedure specific.

References: 1. Silva RA et al. Ophth Surg Lasers Imag Retina 2013.

2. Thomas RL. ADA Poster 2013.

3. Roos N et al. BMJ 2013 (Nov).

4. Sjostrom L. J Int Med 2013.