(1181) Screening and Diagnosis of Gestational Diabetes, and Perinatal Outcomes in Patients with Bariatric Surgery History

Friday, January 31, 2025

4:00 PM – 6:00 PM

Presenting Author(s)

Silpa Annavarapu, MS2 (she/her/hers)

Medical Student
Sidney Kimmel Medical College, Thomas Jefferson University
Philadelphia, PA, United States

Coauthor(s)

CW

Charlette Williams, MD

Resident
Sidney Kimmel Medical College, Thomas Jefferson University
Philadelphia, Pennsylvania, United States
Rodney A. McLaren, Jr., Jr., MD

Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States

Submitting Author(s)

Sarah Boudova, MD, PhD (she/her/hers)

Maternal-Fetal Medicine Fellow
Thomas Jefferson University
Philadelphia, Pennsylvania, United States

Objective: History of bariatric surgery is increasingly common in pregnancy. The glucose tolerance test (GTT) is the gold standard for diagnosing gestational diabetes (GDM), however individuals with a history of bariatric surgery may not tolerate the sugar load and there is concern that the test may be inaccurate in this population. There are no current ACOG guidelines regarding screening for GDM in patients with a history of bariatric surgery. We aimed to characterize how individuals with a history of bariatric surgery were screened and diagnosed with GDM and describe pregnancy outcomes by screening method.

Study Design: This was a retrospective cohort study of pregnancies with a history of bariatric surgery delivered at a major urban referral hospital from 1/17-12/23. Demographics, bariatric surgery history, GDM screening method, pregnancy outcomes and neonatal outcomes were abstracted. The protocol was IRB approved. Data were analyzed with descriptive statistics.

Results: Of the 192 identified pregnancies with a history of bariatric surgery, 17 (8.9%) had pregestational diabetes and 11(5.7%) had no data on screening and were excluded from analysis. Among the remaining 164 pregnancies, 29 (17.7%) were diagnosed with GDM, and 59 (36.0%) did not complete screening.. The most common screening method was exclusive GTT (47, 28.7%), followed by glucose fingersticks (34, 20.7%), followed by mixed screening methods (18, 11.0%) (Table 1). GTT was most commonly used for those with sleeve gastrectomy, while fingersticks were most commonly used for Roux-en-Y. Cesarean delivery occurred in 68, 41.5% pregnancies. Hypertensive disorder of pregnancy occurred in 28, 17.1% pregnancies. The composite adverse neonatal outcome occurred in 40 (24.4%) deliveries and was more common among those diagnosed with GDM (Table 2).

Conclusion: Among pregnancies with a history of bariatric surgery, GDM was common, however, there was a low rate of completed GDM screening. GTT was the most common screening method. Further research is needed to determine the reason for low rates of GDM screening.