Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center

Chevrot, A; Kayem, Gilles; Coupaye, Muriel; Lesage, N.; Msika, Simon; Mandelbrot, Laurent

doi:10.1016/j.ajog.2015.11.017

Cited by 80 publications

(67 citation statements)

References 28 publications

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“…Higher rates of SGA infants have been reported following biliopancreatic diversion compared to RYGB [100]. In a different study, IUGR was more common in women who underwent RYGB compared to gastric banding and sleeve gastrectomy [115]. However, a study by Facchiano et al [116] found no significant differences in outcomes between gastric banding and RYGB in terms of obstetric complications, gestational age or birth weight.…”

Section: Pregnancy After Bariatric Surgerymentioning

confidence: 88%

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

et al. 2017

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Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

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Section: Pregnancy After Bariatric Surgerymentioning

confidence: 88%

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

et al. 2017

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“…Intrauterine growth restriction (IUGR) is increased by 2-3 fold after bariatric surgery (15, 38). In addition, pregnancies in women who had undergone procedures such as Roux-en-Y gastric bypass or RYGB, had a greater risk for SGA in comparison to weight loss procedures that such as LAPBAND, including VSG (11). Though many of the human studies report IUGR with RYGB and not LAPBAND, few studies have determined the occurrence of IUGR by type of surgery.…”

Section: Discussionmentioning

confidence: 99%

Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development

et al. 2018

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Bariatric surgery is increasingly employed to improve fertility and reduce obesity related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy. VSG dams studied on gestational day (G) 19 had reduced circulating T cell (CD3+ and CD8+) populations compared to lean or obese controls. Further, local interleukin 1 β and interleukin 1 receptor antagonist mRNA were increased in placenta of VSG dams. Placental barrier function was also affected, with increased trans-placental permeability to small molecules, increased matrix metalloproteinase 9 expression, and increased apoptosis in VSG. Furthermore, we identified increased placental mTOR signaling that may contribute to preserving the body weight of the fetuses during gestation. These changes occurred in the absence of a macronutrient deficit or gestational hypertension in the VSG dams. In summary, previous VSG in dams may contribute to fetal demise by affecting maternal immune system activity and compromise placental integrity.

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“…The number of obese women in childbearing age undergoing bariatric surgery has risen significantly within the past years [1]. Although bariatric surgery is the most effective treatment for morbid obesity in diabetic patients [2,3], recent studies showed that women after surgery are at higher risk of perinatal complications such as preterm birth or delivering small-forgestational (SGA) infants [4][5][6][7]. In this context, we recently demonstrated a continuous decline in fetal growth throughout pregnancy after gastric bypass surgery, starting at the early second trimester [8].…”

Section: Introductionmentioning

confidence: 99%

“…In this context, we recently demonstrated a continuous decline in fetal growth throughout pregnancy after gastric bypass surgery, starting at the early second trimester [8]. Although the pathophysiologic mechanism beyond this observation remains unclear, it is believed that fetal growth delay is rather caused by nutrient deficiency and postprandial hypoglycemia (due to dumping syndrome) than by growth restriction due to placenta etiology or preeclampsia [5,9].…”

Section: Introductionmentioning

confidence: 99%

Trajectories of Fetal Adipose Tissue Thickness in Pregnancies After Gastric Bypass Surgery

et al. 2019

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Purpose Recent studies showed that women after surgery are at higher risk of delivering small-for-gestational infants. Thus, this study aims to investigate longitudinal changes of fetal subcutaneous adipose tissue thickness (FSCTT) of fetuses conceived after gastric bypass surgery as compared to BMI-matched controls. Methods Retrospective cohort study measuring ultrasound-derived longitudinal trajectories of abdominal FSCTT in 41 singleton pregnancies after gastric bypass surgery compared to 41 BMI-matched controls and 64 obese mothers.Results FSCTT was significantly lower in fetuses of women after GB as compared to BMI-matched controls in the second (mean difference 1.38 mm, p < 0.001) and third trimester of gestation (mean difference 3.37 mm, p < 0.001). Longitudinal analysis revealed significant differences in mean FSCTT trajectories between offspring's in GB mothers, BMI-matched, or obese controls. The ratio of FSCTT and abdominal circumference remained constant in the BMI-matched control group whereas it significantly decreased in fetuses of women after GB. Despite remarkable differences were observed in longitudinally assessed FSCTT, further analyses in the GB subgroup revealed that FSCTT were not influenced by OGTT mean or 120 min glucose values, biochemically hypoglycemia, time since bariatric surgery, or weight loss since surgery. Conclusion In fetuses of mothers with history of bariatric surgery, abdominal FSCTT was markedly reduced. While the underlying mechanisms are not fully understood, a multifactorial genesis including nutritional deficiencies and altered metabolism after bariatric surgery is assumed.

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Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center

Abstract: Malabsorptive bariatric surgery was associated with an increased risk of fetal growth restriction.

Cited by 80 publications

References 28 publications

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development

Trajectories of Fetal Adipose Tissue Thickness in Pregnancies After Gastric Bypass Surgery

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