Pregnancy After Bariatric Surgery

Fisher, Stephanie A.; Stetson, Bethany; Kominiarek, Michelle A.

doi:10.1001/jama.2023.1442

Cited by 9 publications

(14 citation statements)

References 11 publications

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“…Although there is conflicting evidence regarding the effect of bariatric surgery on delivery type, it appears that women who become pregnant after bariatric surgery have a higher risk of cesarean delivery compared to healthy controls [ 35 – 37 ] and lower risk compared to controls with obesity [ 38 , 39 ], as was the case for our study. Higher maternal age and higher prevalence of previous cesarean delivery could explain the higher risk of cesarean delivery reported in some studies [ 9 , 40 , 41 ]. Caregiver bias has also been proposed as a contributing factor [ 35 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Evidence regarding the effect of bariatric surgery on gestational weight gain is conflicting. While most studies suggest that BG leads to lower gestational weight gain [ 9 , 44 – 46 ], others point to similar or even higher gestational weight gain [ 10 , 47 ]. These disparities could be due, in part, to differences in the characteristics of control groups in each study.…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy After Bariatric Surgery—Experience from a Tertiary Center

Ferreira,

von Hafe,

Dias

et al. 2024

OBES SURG

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Introduction It is estimated that most people undergoing bariatric surgery are women of reproductive age; nonetheless, its effects on pregnancy outcomes are not yet fully understood. Methods Retrospective observational study, conducted in a tertiary center in Portugal, included participants in two groups: (1) pregnant women with a history of bariatric surgery (n = 89) and (2) pregnant women with a BMI ≥ 35 kg/m2, without previous bariatric surgery (n = 176). Data was collected from the medical files. Multivariate analysis was conducted to adjust for confounders. Results Pregnancy after bariatric surgery was associated with lower risk of gestational diabetes (15.7% vs. 30.1%, p = 0.002) and cesarean delivery (20.7% vs. 33.5%, p = 0.007), and a higher gestational weight gain (10.58 ± 9.95 vs. 7.33 ± 6.00 kg, p < 0.001). Participants in the bariatric surgery who experienced a gestational weight gain ≤ 10.0 kg had a higher risk of preterm delivery (16.7% vs. 2.5%, p = 0.031). No significant differences were found regarding hypertensive diseases of pregnancy between groups (4.5% vs 11.4%, p = 0.147). Pregnancy after bariatric surgery was associated with lower neonate weight percentile (34.24 ± 21.09 vs. 48.77 ± 27.94, p < 0.001), higher risk of fetal growth restriction (5.6% vs. 0.6%, p = 0.018), and lower risk of fetal macrosomia (0.0% vs. 7.5%, p = 0.005). There were no significant differences in the risk of SGA (12.5% vs. 7.0%, p = 0.127) or LGA neonates (2.3% vs. 6.4%, p = 0.069). Conclusion Pregnancy after bariatric surgery is associated with both risks and benefits, which should be considered by healthcare providers. Pregnancy after bariatric surgery requires individualized care, to ensure adequate gestational weight and avoid micronutrient deficiencies. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pregnancy After Bariatric Surgery—Experience from a Tertiary Center

Ferreira,

von Hafe,

Dias

et al. 2024

OBES SURG

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“…Patients should be aware to avoid pregnancy in the first 1-2 years after surgery as studies have shown a greater likelihood of perinatal and even postsurgical complications such as internal hernias. 32 A comprehensive psychological assessment involves evaluating the patient's mental health, emotional well-being, eating behaviors, body image concerns, and understanding of the surgical procedure and its implications. Optimizing the patient’s psychiatric health preoperatively can improve surgical outcomes and reduce the risk of postoperative psychiatric complications.…”

Section: Preoperative Work-upmentioning

confidence: 99%

Updates in Bariatric Surgery

Hsu,

Farrell

2023

The American Surgeon™

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Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.

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“…Roux-en-Y gastric bypass (RYGB) is a malabsorptive procedure because part of the small intestine is bypassed. This surgery is very effective for weight loss; however, it has the risk of re-operation in 3% to 20% of patients, secondary to complications such as anastomotic stenosis, intestinal obstruction secondary to adhesions, abdominal wall hernias, intussusceptions, and internal hernias [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Emphasizing the diagnostic challenge of finding an internal hernia after RYGB, the literature states that there will be a catastrophic outcome if the diagnosis is missed and timely treatment is not given, high diagnostic suspicion should be raised when a patient has a history of RYGB and severe epigastric pain or umbilical pain [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Petersen’s Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment

Calderón Espinosa de los Monteros,

Castro Segovia,

Arciniega Belmont

2024

Cureus

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Roux-en-Y gastric bypass (RYGB) patients are at risk of creating potential spaces for possible internal hernias during the procedure. During pregnancy, the pregnant uterus elevates the bowel, increasing intra-abdominal pressure. Cases reported to date have described mild abdominal pain and no evidence of peritoneal irritation, with inconclusive ultrasound and MRI findings for diagnosis of Petersen's hernia. We present the case of a 42-year-old female patient with a history of RYGB eight years earlier without complications, with a pregnancy of 34 weeks of gestation. Symptomatology began with colicky abdominal pain in the epigastric, with irradiation to the right upper quadrant. On physical examination, revealed a painful abdomen on the median and deep palpation in the epigastric and right upper quadrant, the rest of the studies were inconclusive. As there was no improvement of the symptoms in 12 hours, an emergency diagnostic laparoscopy was performed, finding a strangulated Petersen's hernia requiring resection, with the closure of the gastric pouch, intestinal anastomosis, and Stamm gastrostomy with closure of the mesenteric gap. Therefore, a pregnant patient presenting with upper quadrant abdominal pain with a history of RYGB, even one with normal labs and imaging, should be assumed to have an internal hernia until proven otherwise. The emergency surgical approach is associated with early resolution and prevents its progression with catastrophic results.

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Pregnancy After Bariatric Surgery

Abstract: This JAMA Insights Clinical Update discusses general adaptations for pregnancy after bariatric surgery, including recommendations regarding nutrition, maternal health, and fetal and neonatal risks.

Cited by 9 publications

References 11 publications

Pregnancy After Bariatric Surgery—Experience from a Tertiary Center

Pregnancy After Bariatric Surgery—Experience from a Tertiary Center

Updates in Bariatric Surgery

Petersen’s Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment

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