Standards of medical care in diabetes—2015 abridged for primary care providers. Clin Diabetes. 2015; 33:(2)97-111

Bhavadharini B, Mahalakshmi MM, Maheswari K Use of capillary blood glucose for screening for gestational diabetes mellitus in resource-constrained settings. Acta Diabetol. 2016; 53:(1)91-7

Bonis C, Lorenzini F, Bertrand M Glucose profiles in pregnant women after a gastric bypass. Obes Surg. 2016; 26:(9)2150-5

Carreau A-M, Nadeau M, Marceau S, Marceau P, Weisnagel SJ. Pregnancy after bariatric surgery: balancing risks and benefits. Can J Diabetes. 2017; 41:(4)432-8

Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017; 356

Crusell M, Nilas L, Svare J, Lauenborg J. A time interval of more than 18 months between a pregnancy and a rouxen-Y gastric bypass increases the risk of iron deficiency and anaemia in pregnancy. Obes Surg. 2016; 26:(10)2457-62

Dabi Y, Thubert T, Benachi A, Ferretti S, Tranchart H, Dagher I. Pregnancies within the first year following sleeve gastrectomy: impact on maternal and fetal outcomes. Eur J Obstet Gynecol Reprod Biol. 2017; 212:190-2

Feichtinger M, Stopp T, Hofmann S Altered glucose profiles and risk for hypoglycaemia during oral glucose tolerance testing in pregnancies after gastric bypass surgery. Diabetologia. 2017; 60:(1)153-7

Jiménez A, Ceriello A, Casamitjana R, Flores L, Viaplana-Masclans J, Vidal J. Remission of type 2 diabetes after Rouxen-Y gastric bypass or sleeve gastrectomy is associated with a distinct glycemic profile. Ann Surg. 2015; 261:(2)316-22

Johansson K, Cnattingius S, Näslund I Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015; 372:(9)814-24

Kominiarek MA. Preparing for and managing a pregnancy after bariatric surgery. Seminars in Perinatology. 2011; 35:(6)356-61

Lee CJ, Clark JM, Schweitzer M Prevalence of and risk factors for hypoglycemic symptoms after gastric bypass and sleeve gastrectomy. Obesity (Silver Spring). 2015; 23:(5)1079-84

Melamed N, Pittini A, Barrett J. Sonographic factors distinguishing late intrauterine growth restriction from late small for gestational age fetuses. Am J Obstet Gynecol. 2016; 214:(1)S104-5

Monteiro LJ, Norman JE, Rice GE, Illanes SE. Fetal programming and gestational diabetes mellitus. Placenta. 2016; 48:S54-60

Ng M, Fleming T, Robinson M Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384:(9945)766-81

Nolan C, Kent E. Rates of stillbirth and neonatal death secondary to IUGR over a 10-year period. Ultrasound in Obstetrics and Gynecology. 2014; 44

Pistrosch F, Ganz X, Bornstein SR, Birkenfeld AL, Henkel E, Hanefeld M. Risk of and risk factors for hypoglycemia and associated arrhythmias in patients with type 2 diabetes and cardiovascular disease: a cohort study under real-world conditions. Acta Diabetol. 2015; 52:(5)889-95

Ryan D, Haddow L, Reynolds R. Early screening for gestational diabetes in obese pregnant women is associated with improved neonatal and maternal outcomes. Conference presentation. Obesity Update. 2018;

Salgado W, Modotti C, Nonino CB, Ceneviva R. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2014; 10:(1)49-54

Shantavasinkul PC, Torquati A, Corsino L. Post-gastric bypass hypoglycaemia: a review. Clin Endocrinol (Oxf). 2016; 85:(1)3-9

Whyte M, Johnson R, Cooke D, Hart K, McCormack M, Shawe J. Diagnosing gestational diabetes mellitus in women following bariatric surgery: A national survey of lead diabetes midwives. Br J Midwifery. 2016; 24:434-8

Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy.Geneva: WHO; 2016

Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016; 16:(1)

Efficacy of oral glucose tolerance testing of pregnant women post bariatric surgery

02 November 2018
Volume 26 · Issue 11


Worldwide, a large proportion of childbearing women are overweight or obese, and it is becoming increasingly common for pregnant women to have undergone bariatric surgery before conceiving. Women with a history of sleeve gastrectomy may not be able to undertake the oral glucose tolerance test, due to the risk of dumping syndrome. There is limited research on the effects of weight loss surgery on the pregnancy oral glucose tolerance test and conducting this test on a woman who has had bariatric surgery may be an inadequate form of diagnosing gestational diabetes mellitus. A cost-effective alternative to an oral glucose tolerance test is to monitor pre-and post-meal blood glucose levels.

Globally, an estimated one in five women aged 20 years or older is obese, defined as a body mass index (BMI) ≥30 kg/m2 (Ng et al, 2014). It is becoming increasingly common for pregnant women to have undergone bariatric surgery before conceiving. Bariatric surgery has been associated with a decreased risk of gestational diabetes and excessive fetal growth; shorter gestation, and an increased risk of small-for-gestationalage fetuses (Johansson et al, 2015). Gestational diabetes mellitus (GDM) is defined as the onset of glucose intolerance in pregnancy and is increasing in prevalence due to a number of factors, including the rising incidence of obesity (Catalano and Shankar, 2017). In the UK, GDM affects between 3% and 5% of all pregnancies (Ryan et al, 2018). GDM is now recognised as one of the most common complications of pregnancy, and has increased by more than 30% worldwide within the past 20 years (Zhu and Zhang, 2016). Gestational diabetes can lead to adverse maternal and fetal outcomes and it is therefore important that GDM is diagnosed and managed appropriately in pregnancy (Monteiro et al, 2016). The World Health Organization (WHO) (2016) recommends diagnosing GDM if any of the following criteria are met:

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month