Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery

Abstract

The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements intake (periconceptional period: 56.8%, trimester 1 (T1): 77.8%, T2: 96.3%, and T3: 100.0%), nutritional deficiencies involved vitamins A (T1: 36.4%, T2: 21.1%, and T3: 40.0%), D (T1: 33.3%, T2: 26.3%, and T3: 8.3%), C (T1: 66.7%, T2: 41.2%, and T3: 83.3%), B1 (T1: 45.5%, T2: 15.4%, and T3: 20.0%), and B9 (T1: 14.3%, T2: 0%, and T3: 9.1%) and selenium (T1: 77.8%, T2: 22.2%, and T3: 50.0%). There was no significant difference in the prevalence of nutritional deficiencies and complications according to surgery procedures and in the prevalence of pregnancy issues according to BMI at the beginning of the pregnancy and time between surgery and pregnancy. Prevalence of micronutritional deficiencies and small-for-gestational-age neonates is high in pregnant women following bariatric surgery. Specific nutritional programmes should be recommended for these women.

Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care

“…Norgaard et al found no difference in the prevalence of SGA prior to, or after, 18 months (level 2++). Other studies also did not find a difference in gestational outcomes according to surgery to conception interval …”

Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome

“…Vitamin A deficiency was reported in 10% to 58% of pregnant women after BS, depending on BS procedure and gestational age [51, 61, 85]. Vitamin A, alone or in combination with other fat-soluble vitamins (D, E, K), has to be supplied if deficiencies are present [60, 61].…”

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

“…In several studies and case reports, evidence could be found that after bariatric surgery women who become pregnant suffer from micronutrient deficiencies, e.g., vitamins A, D, C, B1, and B9 and selenium [74][75][76][77][78]. Furthermore, a study submitted that intake of proteins and omega 3 fatty acids could be difficult [77].…”

“…This underlines the importance of screening for any deficiency and, especially for pregnant or breastfeeding patients, the long-term intake of nutritional supplements like vitamins, minerals, and trace elements [74,76,78,82,83]. By not doing this, severe complications for mother and child could arise [76].…”

“…This underlines the importance of screening for any deficiency and, especially for pregnant or breastfeeding patients, the long-term intake of nutritional supplements like vitamins, minerals, and trace elements [74,76,78,82,83]. By not doing this, severe complications for mother and child could arise [76]. In order to reduce fetal and maternal risk, the guidelines for postoperative management of bariatric patients of the American College of Obstetrical and Gynecology and the French National Authority for Health recommend contraception for at least 12-24 months [30].…”