Pregnancy Following Bariatric Surgery-Medical Complications and Management

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Term Occurence Count Dictionary
acromegaly 1 endocrinologydiseases
cortisol 1 endocrinologydiseasesdrugs
diazoxide 1 endocrinologydiseasesdrugs
hyperinsulinemia 1 endocrinologydiseases
hypoglycemia 20 endocrinologydiseases
obesity 8 endocrinologydiseases
Octreotide 1 endocrinologydiseasesdrugs
acarbose 7 endocrinologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
Octreotide 12426 hyperbilirubinemia, thrombocytopenia, altered carbohydrate metabolism, alopecia and hypertrichosis lanuginosa. Octreotide Somatostatin analogues, of which octreotide is the most commonly studied, act by decreasing gastric emptying
acarbose 8359 viscosity, such as pectin or guar gum, may help to slow down gastric emptying. The α-glucosidase inhibitor, acarbose , can slow down the breakdown and absorption of food sugars. Diazoxide inhibits insulin release from
acarbose 14090 gastrointestinal hormones and reduced incidence of hypoglycemia. Because of its mechanism of action, acarbose when administered alone does not cause hypoglycemia in the fasted state. Acarbose treatment often results
acarbose 14355 unabsorbed carbohydrates undergo bacterial fermentation in the small intestine [[33]]. Rodent studies of acarbose have shown no evidence of impaired fertility or harm to the foetus using the equivalent of nine times
acarbose 14725 dose in man based on body surface area. However, there are no adequate and well-controlled studies of acarbose in pregnant women (FDA Pregnancy Category B) [[37]]. Acarbose is a recognized treatment for postprandial
acarbose 15043 diabetes. Our Case Study (see box) is the first report in the published literature of the successful use of acarbose in postprandial hypoglycemia in pregnancy following bariatric surgery.Continuous Enteral FeedingContinuous
acarbose 16877 foetal hypoglycemia. After careful consideration of further options of management, she was commenced on acarbose in incremental doses up to 100 mg three times daily in the second trimester. Acarbose was well tolerated
acarbose 17612 severe or as frequent as in the first pregnancy and was managed by low GI diet without resorting to acarbose . She proceeded to term and delivered a healthy boy who is also developing normally.Nutrient DeficienciesIt
cortisol 16503 4∙2 mmol/L, serum insulin 51 IU/L and C-peptide 418 pmol/L. Urine tested negative for sulphonylureas. Serum cortisol , thyroid hormones and vitamin and micronutrient levels were satisfactory. Despite dietary management
diazoxide 11912 Safety in pregnancy has not been established and the United States Federal Drug Agency (FDA) has classed diazoxide in Pregnancy Category C (animal reproduction studies have shown an adverse effect on the foetus, and
Select Disease Character Offset Disease Term Instance
acromegaly 13783 have been reported in postmarketing data from a limited number of exposed pregnancies in women with acromegaly .AcarboseAcarbose, an intestinal α-glycosidase inhibitor, delays digestion and absorption of carbohydrates
hyperinsulinemia 9403 occurs 1 to 3 h after meals. It is partly incretin-mediated and is thought to occur in response to hyperinsulinemia following rapid glucose transit into the jejunum (Fig. 1). This results in a reactive hypoglycemia manifesting
hypoglycemia 1185 necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize
hypoglycemia 7821 and rapid glucose absorption (2), which induces a hyperinsulinemic response (3), leading to reactive hypoglycemia 1–3 h after food (late dumping syndrome). Rapid delivery of hyperosmolar chyme to the upper small
hypoglycemia 9290 gastric emptying and help to reduce vasomotor symptoms.Late Dumping SyndromeLate dumping or postprandial hypoglycemia occurs 1 to 3 h after meals. It is partly incretin-mediated and is thought to occur in response to
hypoglycemia 9506 hyperinsulinemia following rapid glucose transit into the jejunum (Fig. 1). This results in a reactive hypoglycemia manifesting as diaphoresis, tremulousness, poor concentration, altered consciousness, palpitation and
hypoglycemia 9754 increase in insulin secretion and insulin sensitivity that occurs in early gestation increases the risk of hypoglycemia in women who conceive following bariatric surgery. It is worth noting in this context that the standard
hypoglycemia 10228 intestine can cause significantly distressing symptoms from early dumping as well as profound reactive hypoglycemia from late dumping. Assessment of home capillary blood glucose (cBG) profiles and/or continuous glucose
hypoglycemia 10616 context.Management of Late DumpingDietary modifications are the mainstay of management of postprandial hypoglycemia and principally include the avoidance of refined carbohydrates in favour of low glycemic index foods.
hypoglycemia 10979 [[33]]. A limited number of pharmacological agents have been used in the treatment of postprandial hypoglycemia in non-pregnant individuals [[33]]. Adding pectin or guar gum to increase the viscosity of food, which
hypoglycemia 13089 cost. Whilst successful long-term treatment with somatostatin analogues in intractable postprandial hypoglycemia following gastric bypass surgery has been described [[35]], there are no adequate studies in pregnant
hypoglycemia 14040 improved glucose tolerance, decreased release of gastrointestinal hormones and reduced incidence of hypoglycemia . Because of its mechanism of action, acarbose when administered alone does not cause hypoglycemia in
hypoglycemia 14138 of hypoglycemia. Because of its mechanism of action, acarbose when administered alone does not cause hypoglycemia in the fasted state. Acarbose treatment often results in bloating, flatulence or diarrhoea, as the unabsorbed
hypoglycemia 14839 pregnant women (FDA Pregnancy Category B) [[37]]. Acarbose is a recognized treatment for postprandial hypoglycemia in non-pregnant individuals [[33]] and has separately been explored in gestational diabetes. Our Case
hypoglycemia 15068 box) is the first report in the published literature of the successful use of acarbose in postprandial hypoglycemia in pregnancy following bariatric surgery.Continuous Enteral FeedingContinuous enteral feeding via a
hypoglycemia 16303 continuous glucose monitoring (CGM; MiniMed Paradigm 522, Medtronic®) confirmed non-fasting, postprandial hypoglycemia , with glucose levels of less than 2.2 mmol/L. Fasting plasma glucose was 4∙2 mmol/L, serum insulin
hypoglycemia 16662 levels were satisfactory. Despite dietary management with a low glycemic index (GI) diet postprandial hypoglycemia increased in severity and frequency, raising concerns of the risk of maternal neuroglycopenia and foetal
hypoglycemia 16780 increased in severity and frequency, raising concerns of the risk of maternal neuroglycopenia and foetal hypoglycemia . After careful consideration of further options of management, she was commenced on acarbose in incremental
hypoglycemia 17022 three times daily in the second trimester. Acarbose was well tolerated with significant reduction in hypoglycemia frequency and severity on cBG and CGM. She proceeded to term and delivered a healthy girl who is developing
hypoglycemia 17273 imaging of the pancreas postdelivery revealed no abnormalities, and there was no further significant hypoglycemia on cBG and CGM. She went on to have a second pregnancy 2 years later. She again experienced hypoglycemic
hypoglycemia 17488 hypoglycemic episodes, typically associated with consumption of high GI foods but not with low GI foods. The hypoglycemia was not as severe or as frequent as in the first pregnancy and was managed by low GI diet without resorting
hypoglycemia 22481 Acarbose is the least hazardous pharmacological option for the management of late dumping/postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize
obesity 1863 affects a quarter of all adult women in Western Europe and Canada, and a third in the USA [[1]]. Whilst obesity in general increases the risk of various weight-related disorders, maternal obesity, defined as a BMI ≥ 30 kg/m2
obesity 1947 USA [[1]]. Whilst obesity in general increases the risk of various weight-related disorders, maternal obesity , defined as a BMI ≥ 30 kg/m2 during pregnancy, in particular increases the risk of various pregnancy
obesity 2466 postpartum haemorrhage and maternal mortality [[2]–[5]]. Whereas lifestyle and dietary measures and anti- obesity pharmacotherapy are recommended as the primary treatment approach for obesity, bariatric surgery remains
obesity 2544 dietary measures and anti-obesity pharmacotherapy are recommended as the primary treatment approach for obesity , bariatric surgery remains the most clinically effective and cost-effective intervention for people
obesity 2664 surgery remains the most clinically effective and cost-effective intervention for people with morbid obesity [[6], [7]]. Thus, the global uptake of bariatric surgery has increased exponentially in the past decade
obesity 3445 (www.scholar.google.com) with a broad range of combinations of the medical subject headings (MeSH) terms, ‘ obesity ’, ‘maternal obesity’, ‘bariatric surgery’, ‘gastric bypass’, ‘gastric band’, ‘sleeve
obesity 3469 broad range of combinations of the medical subject headings (MeSH) terms, ‘obesity’, ‘maternal obesity ’, ‘bariatric surgery’, ‘gastric bypass’, ‘gastric band’, ‘sleeve gastrectomy’, ‘pregnancy’
obesity 15583 reported in the management of dumping syndromes in pregnancy.Case studyA 25-year-old woman with morbid obesity , acanthosis nigricans, polycystic ovarian syndrome, oligomenorrhoea and primary infertility and childhood-onset

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