Nutrition in Pregnancy Following Bariatric Surgery

Slater, Christopher; Morris, Lauren; Ellison, Jodi; Syed, Akheel A.

doi:10.3390/nu9121338

Cited by 39 publications

(79 citation statements)

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“…Conversely, we found an increased odds of SGA (not statistically significant) following bariatric surgery, which is consistent with a population cohort study matched for pre‐surgery BMI . Nutritional deficiencies have been linked with an increased risk of SGA, and antenatal screening for deficiencies is recommended each trimester in pregnancies following bariatric surgery …”

Section: Discussionsupporting

confidence: 89%

Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study

Ibiebele

Gallimore

Schnitzler

et al. 2019

BJOG

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Objectives To describe the population of women having bariatric surgery and compare the pregnancy outcomes for women having bariatric surgery with a non-bariatric surgery population having a first and second pregnancy.Design Population-based record linkage study.Setting New South Wales (NSW), Australia.Population All women aged 15-45 years with a hospital record in NSW (2002NSW ( -2014 and all women giving birth in NSW (1994-2015; n = 1 606 737 women).Methods Pregnancy and birth outcomes were compared between first and second pregnancies using repeated-measures logistic regression and paired Student's t-tests. Bariatric and non-bariatric groups were also compared.Main outcome measures Maternal diabetes, preterm birth (<37 weeks of gestation) and large for gestational age.Results There was a 13-fold increase in hospitalisations for primary bariatric surgery during 2002-2014. Compared with the general birthing population, women who had bariatric surgery experienced higher rates of hypertension, diabetes, and preterm birth. Among women who had bariatric surgery between a first and second pregnancy, there were reduced rates of hypertension (OR 0.39, 95% CI 0.29-0.53), spontaneous preterm birth (OR 0.37, 95% CI 0.16-0.86), infants that were large for gestational age (OR 0.63, 95% CI 0.44-0.88), and the admission of infants to a special care nursery or neonatal intensive care (OR 0.64, 95% CI 0.46-0.90) in the second pregnancy. Rates for small-for-gestational age and gestational diabetes following surgery were 8.3 and 11.4%, respectively Conclusions Bariatric surgery between a first and second pregnancy was associated with reductions in obesity-related adverse pregnancy outcomes. Bariatric surgery performed for the management of obesity in accordance with current clinical criteria is associated with improved pregnancy outcomes in a subsequent pregnancy.Tweetable abstract Bariatric surgery for obesity may improve pregnancy and birth outcomes in a subsequent pregnancy.

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Section: Discussionsupporting

confidence: 89%

Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study

Ibiebele

Gallimore

Schnitzler

et al. 2019

BJOG

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“…In an effort to improve the frequency of haematinic deficiencies and consequent anaemia post-bariatric surgery, a multidisciplinary team approach is crucial to encourage patient engagement to continue taking supplements postoperatively, with a particular focus on women of childbearing age [19]. Our practice includes multidisciplinary, patient-focused approach with peer-group support and the improvements in haematinic levels in our study provide evidence of high levels of medication adherence by patients.…”

Section: Discussionmentioning

confidence: 62%

“…The RNI for folate is 200 μg per day for adults; women require an extra 100 μg during pregnancy [12]. Women who are planning pregnancy are advised 400 μg of folic acid daily until the 12th week of pregnancy [18]; a higher dose of 5 mg per day is recommended for women who have had bariatric surgery [17,19]. Dietary sources of folate include green leafy vegetables and fortified cereals and supplements.…”

Section: Folatementioning

confidence: 99%

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

et al. 2020

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Purpose Bariatric surgery is associated with deficiencies of vitamins and minerals, and patients are routinely advised supplements postoperatively. We studied prevalence of vitamin B 12 , folate and iron deficiencies and anaemia before and after bariatric surgery over 4 years of follow-up. Materials and Methods We performed a retrospective cohort analysis of 353 people with obesity, including 257 (72.8%) women, who underwent gastric bypass (252, 71.4%) or sleeve gastrectomy (101, 28.6%) at our National Health Service bariatric centre in Northwest England. Results At baseline, mean (standard error) age was 46.0 (0.6) years, body mass index 53.1 (0.4) kg/m 2 , serum vitamin B 12 400.2 (16.4) pg/L, folate 7.7 (0.2) μg/L, iron 12.0 (0.3) μmol/L, ferritin 118.3 (8.4) μg/L and haemoglobin 137.9 (0.8) g/L. Frequency of low vitamin B 12 levels reduced from 7.5% preoperatively to 2.3% at 48 months (P < 0.038). Mean folate levels increased from baseline to 48 months by 5.3 μg/L (P < 0.001) but frequency of low folate levels increased from 4.7% preoperatively to 10.3% (P < 0.048). Ferritin levels increased from baseline to 48 months by 51.3 μg/L (P < 0.009). Frequency of low ferritin levels was greater in women (39.1%) than in men (8.9%) at baseline (P < 0.001) and throughout the study period. Haemoglobin was low in 4.6% of all patients at baseline with no significant change over the study period. Conclusion There were notable rates of haematinic insufficiencies in bariatric surgical candidates preoperatively. Our study lends further support to regular supplementation with vitamin B 12 , folic acid, and iron in people undergoing bariatric surgery.

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“…Obese women of reproductive age can suffer from infertility due to hormonally related ovulation dysfunction. Obesity in pregnant women increases the incidence of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), which also influences the way of delivery, with an increase in number of vacuum deliveries and cesarean sections [2,3]. Bariatric surgery is the reference method of treatment for obesity, because of the durability and pace of the weight loss, reduction of symptoms and remission of concomitant diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Women constitute up to 80% of bariatric patients, most of them being of reproductive age [4][5][6]. Bariatric surgery leads to various micronutrient deficiencies in pregnant women, with possible influence on fetal development, though further studies are needed on the subject [3,[7][8][9]. Bariatric surgery and the resulting weight loss, reduction in adipose tissue as well as alteration of the gastrointestinal absorption lead to hormonal and metabolic changes that may affect the well-being of the woman and the fetus.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Bariatric Surgery on Pregnancy and Perinatal Outcomes—A Case-Control Study

Różańska-Walędziak

Bartnik

Janik

et al. 2020

JCM

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Introduction: Obesity in pregnant women increases the incidence of pregnancy-induced comorbidities and the rate of operative deliveries. Purpose of the Study: As bariatric surgery is the reference method of treatment of obesity, we wanted to evaluate its influence on the course of pregnancy and perinatal outcomes. Material and Methods: Data was collected from 627 female patients after bariatric surgery, of whom 107 had a history of pregnancy after the surgery, and 345 non-bariatric patients who had a delivery at a tertiary perinatal center. Sixty-one cases were matched (1:1) with controls for age, pre-pregnancy BMI and presence of pre-pregnancy comorbidities. The main endpoints were gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), small (SGA) and large for gestational age infants (LGA) and cesarean sections (CS). Results: Patients after bariatric procedures were significantly less likely to have GDM (19.67%/37.7%; p = 0.0433), PIH (11.47%/16.39%; p = 0.6072) and preterm delivery (13.11%/37.7%; p = 0.0026). The CS rate was higher (57.38%/40.98%; p = 0.0987). There was an increased risk of SGA (18.03%/13.11%; p = 0.6072) and a decreased risk of LGA (6.56%/16.39%; p = 0.146). Conclusions: Patients after bariatric surgery have a decreased risk of pregnancy-induced comorbidities, preterm deliveries and LGA infants, with an increase in rate of CS and SGA infants compared to general population matched for pre-pregnancy BMI, age and presence of pre-pregnancy comorbidities.

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Nutrition in Pregnancy Following Bariatric Surgery

Cited by 39 publications

References 50 publications

Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study

Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

The Influence of Bariatric Surgery on Pregnancy and Perinatal Outcomes—A Case-Control Study

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