Background/Aim:
Pregnancy in individuals with pre-existing diabetes following bariatric surgery represents a complex, high-risk clinical scenario with limited condition-specific guidance. This population faces unique challenges related to altered gastrointestinal physiology, increased risk of micronutrient deficiencies, and variable glycaemic patterns, including postprandial hyperglycaemia and hypoglycaemia. Existing guidelines address diabetes in pregnancy and post-bariatric care separately, with minimal integration across disciplines. This project aimed to develop multidisciplinary, consensus-based clinical guidelines to support safe, standardised, and clinically applicable care.
Methods:
An 11-member multidisciplinary cross-organisation Special Interest Group (SIG) was established, comprising expertise in endocrinology, obstetrics, bariatric surgery,
dietetics, diabetes education, and midwifery. The scope and purpose of the guidelines were defined through consensus. Guideline statements were developed across five key clinical domains using a structured two-round Delphi process. Statements were informed by a systematic literature review of major electronic databases, alongside existing international guidelines and contemporary evidence. Iterative refinement of statements was undertaken between Delphi rounds to achieve agreement across disciplines. Consensus was predefined as ≥80% agreement, with all final statements achieving 100% agreement. The guideline was developed within a Victorian healthcare context to support feasibility testing and local implementation.
Results:
The consensus produced multidisciplinary, practice-oriented recommendations across five domains:
1. Preconception and Risk Stratification: Guidance on timing of conception, optimisation of nutritional status, and identification of high-risk individuals, including those with pre-existing type 2 diabetes in remission requiring early reassessment and monitoring.
2. Nutrition and Micronutrient Management: Procedure-specific supplementation, high-dose folate, and trimester-based screening for key deficiencies.
3. Glycaemic Assessment and Monitoring: Replacement of oral glucose tolerance testing with structured self-monitoring or continuous glucose monitoring.
4. Clinical Management and Hypoglycaemia: Standardised dietary and clinical strategies for post-bariatric hypoglycaemia.
5. Obstetric and Surgical Considerations: High-risk classification with enhanced fetal surveillance and procedure-specific risk considerations.
Conclusions:
These guidelines provide the first integrated, multidisciplinary framework for managing pregnancy in individuals with pre-existing diabetes following bariatric surgery. By aligning nutrition, glycaemic, obstetric, and surgical care, they offer a clinically actionable model to improve care consistency and maternal–fetal outcomes. Future work will focus on implementation and evaluation across broader healthcare settings.