Women with Roux-en-Y gastric bypass (RYGB) experienced earlier and higher peak glucose levels and a higher frequency of compared to those without RYGB during pregnancy.
RYGB is associated with lower nadir glucose levels during postprandial periods in pregnant women.
Total GLP-1 and insulin levels were markedly elevated in women with RYGB prior to experiencing lower glucose levels.
Glucagon levels were found to be lower in women with RYGB compared to those without.
In the first trimester, higher levels of total GLP-1 and insulin were linked to lower nadir plasma glucose.
In the third trimester, the early postmeal response of plasma glucagon was positively associated with nadir plasma glucose.
Simplified
INTRODUCTION: Roux-en-Y gastric bypass (RYGB) increases the risk of postprandial hypoglycemia, whereas pregnancy decreases insulin sensitivity, which could be expected to counteract hypoglycemia. We examined if RYGB performed prior to pregnancy altered the postprandial glucose metabolism and enteropancreatic hormone responses to a mixed meal test (MMT).
RESEARCH DESIGN AND METHODS: Twenty-three women with RYGB and 23 women matched on prepregnancy body mass index and parity underwent a 4-hour MMT in the first and third trimester of pregnancy with measurement of circulating levels of glucose, insulin, C-peptide, glucose-dependent insulin peptide (GIP), glucagon-like peptide 1 (GLP-1), glucagon, free fatty acids, and lactate. was defined as plasma glucose <3.5 mmol/L.
RESULTS: Women with RYGB had earlier and higher peak glucose, lower nadir glucose levels, and a higher frequency of biochemical hypoglycemia compared with women without RYGB in both the first and third trimester. The lower glucose levels were preceded by markedly elevated total GLP-1 and insulin levels in women with RYGB, whereas total GIP levels were unaltered. The glucagon levels were lower in women with RYGB. In the first trimester MMT, peak and area under the curve of total plasma GLP-1 and serum insulin levels were negatively associated with nadir plasma glucose, while the early postmeal response of plasma glucagon was positively associated with nadir plasma glucose in the third trimester.
CONCLUSIONS: These results provide novel insights into the combined effects of RYGB and pregnancy on postmeal glucose metabolism and enteropancreatic hormone responses during pregnancy, and how these changes associate with an increased risk of postprandial hypoglycemia.
TRIAL REGISTRATION NUMBER: NCT03713060.
Key numbers
9 of 23
Higher frequency of hypoglycemia
Percentage of patients with nadir glucose <3.5 mmol/L in the first trimester.
3×
Total elevation
Peak total levels in patients compared to controls.
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