Endocrine Abstracts

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

Case presentations: Three women aged 25-, 26-, and 36-years-old, who were previously euglycaemic, presented to the joint antenatal clinic with a history of gastric bypass or gastric sleeve surgery. Pregnancy was achieved 3, 7 and 8 years post-BS, respectively. They were referred after the first trimester of pregnancy for postprandial hypoglycaemia, presenting with sweating, palpitations, dizziness and loss of consciousness. Oral glucose tolerance tests (OGTT) were carried out in the first and third cases, at a gestational age of 28 and 29+3 weeks respectively. Subsequently, both women experienced postprandial hypoglycaemia (blood glucose (BG) at 1hr: 2.3mmol/l and 2.6mmol/l, respectively). The women experienced variable degrees of hypoglycaemia during their pregnancies (lowest recorded BG 2.2mmol/l), which was especially pronounced in the first case secondary to co-existent hyperemesis gravidarum. The second case was advised for BG-monitoring and was not offered OGTT. No delivery was uneventful: the first was induced at 38 weeks and required intravenous glycaemic support during delivery. The second underwent emergency caesarean section (CS) at 39 weeks due to failure to progress, under oral glucose-supplementation. The third underwent elective CS at 38 weeks, with no glycaemic imbalance during delivery. All newborns were healthy but of low birth weight (15.7th, 13.7th and 13.7th centile, respectively). Post-delivery there has been significant improvement in hypoglycaemic episodes; only the first woman experienced two early morning episodes before discharge (BG 3.5 mmol/l).

Conclusions: A personal history of BS is associated with a more frequent hypoglycaemic episodes during pregnancy, which appears to be exaggerated in women subjected to OGTT. Glycaemic control appears to improve after delivery.