EPPEL Daniel

Metabolic Disturbances in Early Gestation with Special Focus on Obesity, Hypertriglyceridemia, Bariatric Surgery and Its Effect on Glucometabolism and Neonatal Outcome

Obesity and related metabolic disorders are among the most important health care problems in the western world and affecting more and more women at reproductive age. Maternal hyperglycemia in pregnancy is widely accepted as a major reason for fetal overgrowth and metabolic complications in the new-borns later life, but the impact of other metabolic factors associated with obesity on pregnancy outcome might be of additional or even more importance. Actually, there is sparse information available with focus to elucidate the complex interaction between fetal development, glucose homeostasis and degree of maternal obesity. Recent research suggests that maternal dyslipidemia could be regarded as contributing factor to fetal overgrowth. Based on pregnancy associated complications of obesity, another focus was set on gastric bypass and its impact on glucose metabolism and neonatal outcome. Implications of gastric bypass surgery on glycemic variability have been studied in non-pregnant women, however, longitudinal examinations during gestation and possible implications for the growing fetus are actually missing.

The objective of this thesis is to characterize associations of glucose metabolism in early pregnancy with various conditions including obesity, hypertriglyceridemia and gastric bypass and its relation to neonatal outcome.

In order to examine the pathophysiologic patterns of glucose metabolism in association with fasting triglycerides in early pregnancy, a prospective study with pregnant women will be analyzed. In addition to elucidate the interaction between neonatal development, glucose metabolism and maternal obesity during early pregnancy, another prospective study with females will be conducted. Further, the glycemic dysregulations after gastric bypass and their interaction with physiologic adaptions during human pregnancy and fetal development will be assessed in a prospective study with pregnant women with history of bariatric surgery.

In summary this thesis should give an insight into the complex interaction between obesity related conditions, glucose metabolism and fetal development. Pathophysiological pathways need to be elucidated in order to develop sufficient intervention strategies and to prevent complications such as macrosomia, obstetric emergencies or an increased risk for obesity and overt diabetes in the offspring.

Methods and Skills:

Clinical studies

Publications:

Eppel D, Göbl CS. Pregnancy after bariatric surgery: a growing challenge in feto-maternal medicine. Am J Clin Nutr 111: 250-251, 2020

Eppel D, Feichtinger M, Lindner T, Kotzaeridi G, Rosicky I, Yerlikaya-Schatten G, Eppel W, Husslein P, Tura A, Göbl CS. Association between maternal triglycerides and disturbed glucose metabolism in pregnancy. Acta Diabetol: Online ahead of print, 2021