Screening for Gestational Diabetes in Post-Bariatric Patients: Diagnostic Challenges and Management Recommendations

• DOI: https://doi.org/10.22533/at.ed.5157282602046

• Palavras-chave: gestational diabetes; bariatric surgery; screening; high-risk pregnancy.

• Keywords: gestational diabetes; bariatric surgery; screening; high-risk pregnancy.

• Abstract:

  Obesity is a major risk factor for pregnancy complications, including gestational diabetes mellitus (GDM). Bariatric surgery has established itself as an effective strategy for managing severe obesity and reducing metabolic comorbidities, including type 2 diabetes mellitus. However, the growing number of women of reproductive age undergoing bariatric procedures poses specific challenges for prenatal care, particularly regarding GDM screening. The oral glucose tolerance test (OGTT), the standard method for diagnosing GDM, has significant limitations in this population due to the risk of dumping syndrome and postprandial glycemic variability. The present study aims to review the literature on strategies for screening for GDM in post-bariatric pregnant women, discussing the limitations of traditional methods and proposed diagnostic alternatives. This is a narrative literature review conducted through a search of international databases, including PubMed, Scopus, and SciELO, using search terms related to bariatric surgery, gestational diabetes, and screening. The analysis shows that the OGTT is not recommended after malabsorptive or mixed procedures, with serial capillary glucose monitoring suggested as a safer alternative. There is still a lack of robust consensus in international guidelines, which reinforces the need for standardization of clinical practices and prospective studies of higher methodological quality. It is concluded that screening for GDM in post-bariatric patients requires an individualized approach, based on the type of surgical procedure and the maternal metabolic profile.