Gestational Diabetes Screening in a Bariatric Patient

You're pregnant, and you have also had a gastric bypass. 

You are terrified of taking the gestational diabetes screening, because it's typically done with a 50-sugar-gram sickly sweet syrup, Glucola. 

"It's going to make me dump!  OMG!"

 

And, it might.  It's a highly concentrated dumping potion, and you don't HAVE TO have it done.  Say no.

Of course your OB/GYN or midwife MUST KNOW that you're a gastric bypass post op, and there ARE OPTIONS aside from the obvious.  Ask for them.  You may have to educate the doctor.

From:  Management and Outcomes of Pregnancy following Bariatric Surgery

Prenatal Screening Tests in Bariatric Surgical Patients
Screening for gestational diabetes is recommended in all pregnancies; however, post-GBP patients may be unable to tolerate either the classic 50-gram glucose challenge or the 100-gram oral glucose tolerance test due to dumping syndrome.

Dumping syndrome occurs because rapid gastric emptying of hyperosmolar contents directly into the small bowel after GBP leads to fluid shifts into the bowel lumen, resulting in distention.19 In early dumping syndrome, patients present with abdominal cramping, bloating, nausea, vomiting, and diarrhea. Later, a subsequent release of excessive insulin causes subsequent hypoglycemia. Therefore, late dumping syndrome patients present with tachycardia, palpitations, agitation, and diaphoresis.

Landsberger, et al., suggested using modified glucose testing.

They recommend obtaining a fasting blood glucose level and a two-hour postprandial level after consuming the most carbohydrate-loaded breakfast the patient can tolerate.

If fasting and two-hour postprandial glucose levels are less than 95mg/dL and 120mg/dL respectively, they are considered normal. Landsberger also recommends following hemoglobin, hematocrit, serum iron, ferritin, erythrocyte folate, methylmalonic acid, albumin, prealbumin, serum calcium, phosphate, and 25-hydroxy vitamin D levels. They assert that erythrocyte folate is a better indicator of true deficiency, whereas serum folate merely reflects recent oral intake, and that methylmalonic acid is more sensitive in detecting vitamin B12 deficiency. Finally, Wax, et al., recommend that second trimester maternal serum a-fetoprotein and ultrasound screening be offered, even if current data reflects that the risk of NTDs is theoretical.21

But, a pregnancy without the danger of gestational diabetes is worth it. You may find that even if you had it in a previous pregnancy -- since WLS it might not occur.