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

Abstract

Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.

Nutritional Risks in Adolescents After Bariatric Surgery

“…23 Our findings support the recommendation to avoid pregnancy in the first 1-2 years after surgery and to carefully monitor nutritional status, dietary intake, and supplementation during pregnancy. 24 Recognizing that dietary intake and composition in the first postoperative year may not reflect long-term intake, 23,25 we also assessed changes in nutritional status from 1 to 5 years to determine if risk evolves over time. The continued increase in iron, B 12 (RYGB only), vitamin D deficiencies, and abnormal PTH (RYGB only) after the first postoperative year is particularly worrisome, given the longer potential lifespan of these youth.…”

How Can Maternal Lifestyle Interventions Modify the Effects of Gestational Diabetes in the Neonate and the Offspring? A Systematic Review of Meta-Analyses

“…Compared with mothers with the same pre-gestational BMI, BS is associated with a significantly decreased risk of macrosomia, but also with an increased risk of low birth weight. In addition, BS exposes pregnant women to the risk of nutritional deficiencies with poorly known effects in the newborn and the offspring [42]. This shows that pre-gestational weight loss may have positive effects in limiting fetal growth, but that it has to be dosed reasonably to avoid adverse effects.…”

How to Treat Hernias in Pregnant Women?

“…Thus, BS may have a serious impact on these patients during the subsequent pregnancy [29]. Our review of studies demonstrated that BS has positive effects on metabolic diseases and fertility; however, it may carry medical and surgical complications for mothers and babies, such as IH, bowel intussusception, bowel obstruction, gastric band slippage, bowel volvulus, gastro-jejunal bleeding, cholelithiasis, and maternal or fetal death [28]. To minimize these adverse effects, those who undergo BS are advised to avoid pregnancy for 12-24 months after BS [30].…”

“…Obesity is a significant health problem worldwide these days. Among the available therapeutic options for obesity, BS appears to be the best weight-reduction therapy, with a better long-term outcome [28]. A considerable number of patients undergoing BS are females in their childbearing age, and most likely, they will become pregnant in the future.…”