Effects of Bariatric surgery on Pregnancy Outcomes and Fetal Development

Bariatric surgery, such as sleeve gastrectomy (SG), is the most effective method for sustained weight loss. SG provides other metabolic benefits and improves obesity-related comorbidities, yet pregnancy after bariatric surgery has been associated with increased risk for small for gestational age (SGA) infants. In this study, female ICR mice underwent either SG or sham surgery, followed by an oral glucose tolerance test (OGTT), mating and a repeated OGTT during pregnancy. Offspring were weighed at birth (P1) and at weaning (P21), and pancreas tissue was sampled for histology at both time points. Our results demonstrate longer periods of hypoglycemia during an OGTT, both before and during pregnancy, as well as lower birth weight in females who underwent SG in comparison to sham surgery. We suggest that both effects are attributed to maternal hyperinsulinemic-hypoglycemia, induced by an increased secretion of GLP-1. This results in fetal hypoglycemia, hypoinsulinemia and thereby poor fetal growth. In the next part of the study, we attempt to reverse SGA using a GLP-1 receptor antagonist (exendin 9-39), and further examine the effect of post-SG intrauterine metabolic environment on the development of the endocrine pancreas.