Objective Due to the global increase in obesity rates and success of bariatric surgery in weight reduction, an increasing number of women now present pregnant with a previous bariatric procedure. This study investigates the extent of bariatric-associated metabolic and gut microbial alterations during pregnancy and their impact on fetal development. Design A parallel metabonomic (molecular phenotyping based on proton nuclear magnetic resonance spectroscopy) and gut bacterial (16S ribosomal RNA gene amplicon sequencing) profiling approach was used to determine maternal longitudinal phenotypes associated with malabsorptive/mixed (n=25) or restrictive (n=16) procedures, compared with women with similar early pregnancy body mass index but without bariatric surgery (n=70). Metabolic profiles of offspring at birth were also analysed. Results Previous malabsorptive, but not restrictive, procedures induced significant changes in maternal metabolic pathways involving branched-chain and aromatic amino acids with decreased circulation of leucine, isoleucine and isobutyrate, increased excretion of microbial-associated metabolites of protein putrefaction (phenylacetlyglutamine, p-cresol sulfate, indoxyl sulfate and p-hydroxyphenylacetate), and a shift in the gut microbiota. The urinary concentration of phenylacetylglutamine was significantly elevated in malabsorptive patients relative to controls (p=0.001) and was also elevated in urine of neonates born from these mothers (p=0.021). Furthermore, the maternal metabolic changes induced by malabsorptive surgery were associated with reduced maternal insulin resistance and fetal/birth weight. Conclusion Metabolism is altered in pregnant women with a previous malabsorptive bariatric surgery. These alterations may be beneficial for maternal outcomes, but the effect of elevated levels of phenolic and indolic compounds on fetal and infant health should be investigated further.

中文翻译：

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既往减肥手术孕妇的纵向代谢和肠道细菌分析

目的 由于全球肥胖率的增加和减肥手术在减重方面的成功，越来越多的女性现在因既往减肥手术而怀孕。本研究调查了妊娠期间与肥胖症相关的代谢和肠道微生物改变的程度及其对胎儿发育的影响。设计 使用平行代谢组学（基于质子核磁共振波谱的分子表型分析）和肠道细菌（16S 核糖体 RNA 基因扩增子测序）分析方法来确定与吸收不良/混合（n=25）或限制性（n= 16) 手术，与具有相似早期妊娠体重指数但未进行减肥手术的女性 (n=70) 进行比较。还分析了出生时后代的代谢特征。结硫酸盐、硫酸吲哚酚和对羟基苯乙酸盐），以及肠道微生物群的转变。与对照组相比，吸收不良患者的尿液中苯乙酰谷氨酰胺浓度显着升高 (p=0.001)，并且在这些母亲所生新生儿的尿液中也升高 (p=0.021)。此外，吸收不良手术引起的母体代谢变化与母体胰岛素抵抗和胎儿/出生体重降低有关。结论 先前接受过吸收不良减肥手术的孕妇的代谢发生了改变。这些改变可能有益于母体结局，但应进一步研究酚类和吲哚类化合物水平升高对胎儿和婴儿健康的影响。