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Erschienen in: Obesity Surgery 9/2016

12.01.2016 | Original Contributions

Glucose Profiles in Pregnant Women After a Gastric Bypass

Findings from Continuous Glucose Monitoring

verfasst von: Camille Bonis, Françoise Lorenzini, Monelle Bertrand, Olivier Parant, Pierre Gourdy, Charlotte Vaurs, Laurent Cazals, Patrick Ritz, Hélène Hanaire

Erschienen in: Obesity Surgery | Ausgabe 9/2016

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Abstract

Background

The diagnosis of gestational diabetes mellitus (GDM) usually requires an oral glucose tolerance test, but this procedure seems inappropriate after gastric bypass surgery (Roux-en-Y gastric bypass (RYGB)) due to specific altered glycemic responses. We aimed here at describing continuous glucose monitoring (CGM) profile of pregnant women after RYGB.

Methods

CGM was performed in 35 consecutive pregnant women after RYGB at 26.2 ± 5 weeks of gestation.

Results

After RYGB, pregnant women display high postprandial interstitial glucose (IG) peaks and low IG before and 2 h after meals. The postprandial IG peak is reached early, within 54 ± 9 min. The maximum IG values reach 205 mg/dl, and the percentage of time above 140 mg/dl (6.6 ± 7 %) is similar to what is described in GDM women.

Conclusions

This study is the first to describe CGM profile in pregnant women after RYGB. CGM features are similar to those of non-pregnant post-RYGB patients, characterized by wide and rapid changes in postprandial IG, and high exposure to hyperglycemia. The exposure to hyperglycemia is similar to what is reported in GDM although the time to postprandial peak is shorter. CGM could be an additional useful approach to screen for glucose intolerance during pregnancy after RYGB.
Literatur
1.
Zurück zum Zitat Wax JR, Cartin A, Wolff R, et al. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008;18:1517–21.CrossRefPubMed Wax JR, Cartin A, Wolff R, et al. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008;18:1517–21.CrossRefPubMed
2.
Zurück zum Zitat Belogolovkin V, Salihu HM, Weldeselasse H, et al. Impact of prior bariatric surgery on maternal and fetal outcomes among obese and non-obese mothers. Arch Gynecol Obstet. 2012;285:1211–8.CrossRefPubMed Belogolovkin V, Salihu HM, Weldeselasse H, et al. Impact of prior bariatric surgery on maternal and fetal outcomes among obese and non-obese mothers. Arch Gynecol Obstet. 2012;285:1211–8.CrossRefPubMed
3.
Zurück zum Zitat Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.CrossRefPubMed Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.CrossRefPubMed
4.
Zurück zum Zitat International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.CrossRefPubMedCentral International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.CrossRefPubMedCentral
5.
Zurück zum Zitat Roslin MS, Dudiy Y, Brownlee A, et al. Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch. Surg Endosc. 2014;28:91–9.CrossRefPubMed Roslin MS, Dudiy Y, Brownlee A, et al. Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch. Surg Endosc. 2014;28:91–9.CrossRefPubMed
6.
Zurück zum Zitat Wittgrove AC, Jester L, Wittgrove P, et al. Pregnancy following gastric bypass for morbid obesity. Obes Surg. 1998;8:461–4.CrossRefPubMed Wittgrove AC, Jester L, Wittgrove P, et al. Pregnancy following gastric bypass for morbid obesity. Obes Surg. 1998;8:461–4.CrossRefPubMed
7.
Zurück zum Zitat Wax JR, Pinette MG, Cartin A, et al. Female reproductive issues following bariatric surgery. Obstet Gynecol Surv. 2007;62:595–604.CrossRefPubMed Wax JR, Pinette MG, Cartin A, et al. Female reproductive issues following bariatric surgery. Obstet Gynecol Surv. 2007;62:595–604.CrossRefPubMed
9.
Zurück zum Zitat Freitas C, Araújo C, Caldas R, et al. Effect of new criteria on the diagnosis of gestational diabetes in women submitted to gastric bypass. Surg Obes Relat Dis. 2014;S1550–7289. Freitas C, Araújo C, Caldas R, et al. Effect of new criteria on the diagnosis of gestational diabetes in women submitted to gastric bypass. Surg Obes Relat Dis. 2014;S1550–7289.
10.
Zurück zum Zitat O’sullivan JB, Mahan CM. Criteria for oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278–85.PubMed O’sullivan JB, Mahan CM. Criteria for oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278–85.PubMed
11.
Zurück zum Zitat Kim SH, Liu TC, Abbasi F, et al. Plasma glucose and insulin regulation is abnormal following gastric bypass surgery with or without neuroglycopenia. Obes Surg. 2009;19:1550–6.CrossRefPubMed Kim SH, Liu TC, Abbasi F, et al. Plasma glucose and insulin regulation is abnormal following gastric bypass surgery with or without neuroglycopenia. Obes Surg. 2009;19:1550–6.CrossRefPubMed
12.
Zurück zum Zitat Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92:4678–85.CrossRefPubMed Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92:4678–85.CrossRefPubMed
13.
Zurück zum Zitat Hanaire H, Bertrand M, Guerci B, et al. High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass. Diabetes Technol Ther. 2011;13:625–30.CrossRefPubMed Hanaire H, Bertrand M, Guerci B, et al. High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass. Diabetes Technol Ther. 2011;13:625–30.CrossRefPubMed
14.
Zurück zum Zitat Yogev Y, Ben–Haroush A, Chen R, et al. Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women. Am J Obstet Gynecol. 2004;191:949–53.CrossRefPubMed Yogev Y, Ben–Haroush A, Chen R, et al. Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women. Am J Obstet Gynecol. 2004;191:949–53.CrossRefPubMed
15.
Zurück zum Zitat Bühling KJ, Kurzidim B, Wolf C, et al. Introductory experience with the continuous glucose monitoring system (CGMS; Medtronic Minimed) in detecting hyperglycemia by comparing the self-monitoring of blood glucose (SMBG) in non-pregnant women and in pregnant women with impaired glucose tolerance and gestational diabetes. Exp Clin Endocrinol Diabetes. 2004;112:556–60.CrossRefPubMed Bühling KJ, Kurzidim B, Wolf C, et al. Introductory experience with the continuous glucose monitoring system (CGMS; Medtronic Minimed) in detecting hyperglycemia by comparing the self-monitoring of blood glucose (SMBG) in non-pregnant women and in pregnant women with impaired glucose tolerance and gestational diabetes. Exp Clin Endocrinol Diabetes. 2004;112:556–60.CrossRefPubMed
16.
Zurück zum Zitat Bühling KJ, Winkel T, Wolf C, et al. Optimal timing for postprandial glucose measurement in pregnant women with diabetes and a non-diabetic pregnant population evaluated by the Continuous Glucose Monitoring System (CGMS). J Perinat Med. 2005;33:125–31.CrossRefPubMed Bühling KJ, Winkel T, Wolf C, et al. Optimal timing for postprandial glucose measurement in pregnant women with diabetes and a non-diabetic pregnant population evaluated by the Continuous Glucose Monitoring System (CGMS). J Perinat Med. 2005;33:125–31.CrossRefPubMed
17.
Zurück zum Zitat Siegmund T, Rad NT, Ritterath C, et al. Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values. Eur J Obstet Gynecol Reprod Biol. 2008;139:46–52.CrossRefPubMed Siegmund T, Rad NT, Ritterath C, et al. Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values. Eur J Obstet Gynecol Reprod Biol. 2008;139:46–52.CrossRefPubMed
18.
Zurück zum Zitat Harmon KA, Gerard L, Jensen DR, et al. Continuous glucose profiles in obese and normal-weight pregnant women on a controlled diet: metabolic determinants of fetal growth. Diabetes Care. 2011;34:2198–204.CrossRefPubMedPubMedCentral Harmon KA, Gerard L, Jensen DR, et al. Continuous glucose profiles in obese and normal-weight pregnant women on a controlled diet: metabolic determinants of fetal growth. Diabetes Care. 2011;34:2198–204.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Mazze R, Yogev Y, Langer O. Measuring glucose exposure and variability using continuous glucose monitoring in normal and abnormal glucose metabolism in pregnancy. J Matern Fetal Neonatal Med. 2012;25:1171–5.CrossRefPubMed Mazze R, Yogev Y, Langer O. Measuring glucose exposure and variability using continuous glucose monitoring in normal and abnormal glucose metabolism in pregnancy. J Matern Fetal Neonatal Med. 2012;25:1171–5.CrossRefPubMed
21.
Zurück zum Zitat Chen R, Yogev Y, Ben–Haroush A, et al. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern-Fetal Neonatal Med. 2003;14:256–60.CrossRefPubMed Chen R, Yogev Y, Ben–Haroush A, et al. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern-Fetal Neonatal Med. 2003;14:256–60.CrossRefPubMed
22.
Zurück zum Zitat Ben-Haroush A, Yogev Y, Chen R, et al. The postprandial glucose profile in the diabetic pregnancy. Am J Obstet Gynecol. 2004;191:576–81.CrossRefPubMed Ben-Haroush A, Yogev Y, Chen R, et al. The postprandial glucose profile in the diabetic pregnancy. Am J Obstet Gynecol. 2004;191:576–81.CrossRefPubMed
23.
Zurück zum Zitat Wittgrove C, Tremblay. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.CrossRefPubMed Wittgrove C, Tremblay. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.CrossRefPubMed
24.
Zurück zum Zitat Halverson JD, Kramer J, Cave A, et al. Altered glucose tolerance, insulin response, and insulin sensitivity after massive weight reduction subsequent to gastric bypass. Surgery. 1982;92:235–40.PubMed Halverson JD, Kramer J, Cave A, et al. Altered glucose tolerance, insulin response, and insulin sensitivity after massive weight reduction subsequent to gastric bypass. Surgery. 1982;92:235–40.PubMed
25.
Zurück zum Zitat Vaurs C, Brun JF, Bérard E, et al. A beta-cell pancreatic dysfunction participates in the hyperglycemic peaks observed after gastric bypass surgery of obese patients. Surg Obes Relat Dis. 2015;in Press. Vaurs C, Brun JF, Bérard E, et al. A beta-cell pancreatic dysfunction participates in the hyperglycemic peaks observed after gastric bypass surgery of obese patients. Surg Obes Relat Dis. 2015;in Press.
26.
Zurück zum Zitat Mazze RS, Strock E, Wesley D, et al. Characterizing glucose exposure for individuals with normal glucose tolerance using continuous glucose monitoring and ambulatory glucose profile analysis. Diabetes Technol Ther. 2008;10:149–59.CrossRefPubMed Mazze RS, Strock E, Wesley D, et al. Characterizing glucose exposure for individuals with normal glucose tolerance using continuous glucose monitoring and ambulatory glucose profile analysis. Diabetes Technol Ther. 2008;10:149–59.CrossRefPubMed
27.
Zurück zum Zitat Group JDRFCGMS, Fox LA, Beck RW, et al. Variation of interstitial glucose measurements assessed by continuous glucose monitors in healthy, nondiabetic individuals. Diabetes Care. 2010;33:1297–9.CrossRef Group JDRFCGMS, Fox LA, Beck RW, et al. Variation of interstitial glucose measurements assessed by continuous glucose monitors in healthy, nondiabetic individuals. Diabetes Care. 2010;33:1297–9.CrossRef
28.
Zurück zum Zitat Dalfrà MG, Sartore G, Di Cianni G, et al. Glucose variability in diabetic pregnancy. Diabetes Technol Ther. 2011;13:853–9.CrossRefPubMed Dalfrà MG, Sartore G, Di Cianni G, et al. Glucose variability in diabetic pregnancy. Diabetes Technol Ther. 2011;13:853–9.CrossRefPubMed
29.
Zurück zum Zitat Herranz L, Pallardo LF, Hillman N, et al. Maternal third trimester hyperglycaemic excursions predict large-for-gestational-age infants in type 1 diabetic pregnancy. Diabetes Res Clin Pract. 2007;75:42–6.CrossRefPubMed Herranz L, Pallardo LF, Hillman N, et al. Maternal third trimester hyperglycaemic excursions predict large-for-gestational-age infants in type 1 diabetic pregnancy. Diabetes Res Clin Pract. 2007;75:42–6.CrossRefPubMed
30.
Zurück zum Zitat Taslimi MM, Navabi K, Acosta R, et al. Concealed maternal blood glucose excursions correlate with birth weight centile. J Diabetes Sci Technol. 2008;2:456–60.CrossRefPubMedPubMedCentral Taslimi MM, Navabi K, Acosta R, et al. Concealed maternal blood glucose excursions correlate with birth weight centile. J Diabetes Sci Technol. 2008;2:456–60.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Ceriello A, Ihnat MA. ‘Glycaemic variability’: a new therapeutic challenge in diabetes and the critical care setting. Diabet Med. 2010;27:862–7.CrossRefPubMed Ceriello A, Ihnat MA. ‘Glycaemic variability’: a new therapeutic challenge in diabetes and the critical care setting. Diabet Med. 2010;27:862–7.CrossRefPubMed
32.
Zurück zum Zitat Kjær MM, Lauenborg J, Breum BM, et al. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013;208:464.e1–5.CrossRef Kjær MM, Lauenborg J, Breum BM, et al. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013;208:464.e1–5.CrossRef
33.
Zurück zum Zitat Roos N, Neovius M, Cnattingius S, et al. Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study. BMJ. 2013;347:f6460.CrossRefPubMedPubMedCentral Roos N, Neovius M, Cnattingius S, et al. Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study. BMJ. 2013;347:f6460.CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Bennett WL, Gilson MM, Jamshidi R, et al. Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data. BMJ. 2010;340:c1662.CrossRefPubMedPubMedCentral Bennett WL, Gilson MM, Jamshidi R, et al. Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data. BMJ. 2010;340:c1662.CrossRefPubMedPubMedCentral
Metadaten
Titel
Glucose Profiles in Pregnant Women After a Gastric Bypass
Findings from Continuous Glucose Monitoring
verfasst von
Camille Bonis
Françoise Lorenzini
Monelle Bertrand
Olivier Parant
Pierre Gourdy
Charlotte Vaurs
Laurent Cazals
Patrick Ritz
Hélène Hanaire
Publikationsdatum
12.01.2016
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 9/2016
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2061-z

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