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Title: Pregnancy following Bariatric Surgery : feto-placental and neonatal considerations
Author: Maric, Tanya
ISNI:       0000 0004 8499 4646
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2019
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The prevalence of obesity in pregnancy is continuing to rise. Obese women have a three-fold risk of developing gestational diabetes mellitus (GDM), large for gestational age neonates (LGA) and the risk of preeclampsia (PE) doubles for every 5-7kg/m2 increase in pre-pregnancy bodyweight. Bariatric Surgery (BS) is an effective treatment for sustained weight loss with a rapid increase in the number of procedures performed in the last 6 years. Long-term studies in non-pregnant populations have demonstrated that BS significantly improves insulin sensitivity and type 2 diabetes mellitus (T2DM) leading to long-term remission of the condition and improves cardiovascular outcomes. Numerous retrospective studies have shown that pregnancy following BS is associated with a reduced risk of GDM/LGA neonates and hypertensive disorders, but increased risk of small for gestational age (SGA) neonates and late preterm delivery, relative to pregnancies with similar maternal pre-surgery and pre-pregnancy BMI. The increased risk of SGA babies appears to be higher in patients who have undergone a malabsorptive procedure. The underlying causes of fetal growth restriction in this group is unknown and warrants further investigation to enable the development and application of preventative strategies. This study is a prospective, observational study aiming to investigate the effect of BS on perinatal growth and metabolic profile. We investigated the intra-uterine environment, metabolic profile and body composition of offspring of women who had undergone a previous BS compared to women without previous surgery. • Using 2D ultrasound, the intra-uterine fetal environment was assessed by measuring fetal growth velocity and feto-placental Doppler indices, longitudinally, at four timepoints during gestation to assess whether placental dysfunction plays a role in the reduction in fetal growth, seen in this population. • The intra-uterine fetal body composition was determined by calculating fractional limb (thigh and arm) volumes using 3D ultrasound and software. This was followed by anthropometric measurements at birth. • In order to assess the neonatal metabolic profile at delivery, neonatal insulin resistance from venous cord blood using HOMA-IR, a surrogate marker of insulin resistance, peptides involved in glucose metabolism and inflammatory markers were measured. • Finally, we investigated the placental expression of insulin-like growth factors, their binding proteins and glucose transporters as well as other peptides known to influence fetal growth.
Supervisor: Savvidou, Makrina Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral