References
Diagnosing gestational diabetes mellitus in women following bariatric surgery: A national survey of lead diabetes midwives
Abstract
Background:
Bariatric surgery is becoming more common among women of fertile age to manage obesity. The number of pregnancies following bariatric surgery is, therefore, likely to rise. The standard oral glucose tolerance test (OGTT) may lead to dizziness, sweating and collapse in people after some types of bariatric surgery.
Aims:
In view of this potential pitfall in the diagnosis of gestational diabetes mellitus (GDM) after bariatric surgery, the authors surveyed midwifery units to establish current practice for the screening and diagnosis of GDM in women who have had bariatric surgery.
Methods:
Out of 164 English obstetric units, 120 email surveys were sent to a network of lead diabetes midwives in units across England.
A reminder email was sent 4 weeks later.
Findings:
Twenty-seven (22.5%) responses were received. Five respondents (26%) had specific policies in place to manage pregnancies after bariatric surgery. A wide variety of approaches to GDM screening and diagnosis were used in women with a history of bariatric surgery. The OGTT was the most widely used test after bariatric surgery.
Conclusions:
There is a need for national clinical guidelines to be developed for the diagnosis of GDM after bariatric surgery.
In the UK, approximately one fifth of women aged 16–40 years are obese (body mass index (BMI) ≥ 30 kg/m2) and half of all women are either obese or overweight (Buchwald et al, 2009). Obesity is a substantial risk factor for type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM). Women with pre-existing diabetes have a fivefold increased risk of stillbirth, a threefold increased risk of perinatal mortality and a threefold increased risk of fetal congenital anomaly (Macintosh et al, 2006; Bell et al, 2012; Tennant et al, 2014).
Women are increasingly turning to bariatric surgery to manage their obesity; worldwide, 49% of patients undergoing bariatric surgery are women of childbearing age (18–45 years) (Roehrig et al, 2007; Maggard et al, 2008). Gastric banding, Rouxen-Y gastric bypass (RYGB) and sleeve gastrectomy are the most common procedures performed in the UK (Welbourn et al, 2014). Gastric banding may be considered a restrictive procedure as it limits the amount of food entering the stomach. Gastric bypass is sometimes considered to have a restrictive element (reduction in stomach size) as well as a malabsorptive component (due to a shortened length of intestine). Laparoscopic sleeve gastrectomy is performed in 16% of cases and involves reduction of the stomach to a quarter of its size. It is a more recent procedure and is capable of achieving significant weight loss and T2DM remission (Kehagias et al, 2013).
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