Complexities with diagnosis and management of symptomatic hypoglycemia during pregnancy post-bariatric surgery: a scoping review

INTRODUCTION: Post-bariatric surgery hypoglycemia (PBH) in pregnancy is an important yet likely under-recognized complication. It is associated with maternal and fetal risks, including lifestyle implications, reduced cognition, intrauterine growth restriction and premature delivery. Management is challenging, with no specific guidelines targeted to care in pregnancy published. AREAS COVERED: We conducted a scoping review, searching PUBMED, EMBASE, and CINAHL databases for all relevant studies of PBH in pregnancy between June 1974 and 2025. Our review identified 16 papers discussing 20 cases. Dietary management alone showed success in 9/20 cases. Several trialed pharmacological treatment alongside with mixed response: 1/20 cases trialed Nifedipine (partial improvement in symptoms), 3/20 Acarbose (variable success noted), 2/20 Octreotide (not tolerated) and 1/20 Diazoxide (improvement in symptoms noted). Complications reported include maternal nutritional deficiencies (3/20), neonatal hypoglycemia (3/20), fetal growth restriction (2/20), premature delivery (3/20), and neonatal death (1/20). EXPERT OPINION: PBH during pregnancy has great health and psychological implications, with risks to both mother and neonate. Mainstay management of dietary intervention leaves much to be desired, with continuation of recurrent PBH in the majority of cases. Randomized controlled trials investigating safety and efficacy of pharmacological intervention during pregnancy are essential.