Pregnancy after bariatric surgery: improving outcomes for mother and child

Abstract

The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS). These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy.

Care of Women with Obesity in Pregnancy

“…A review of the current evidence 193 concluded that there is a better overall obstetric outcome after bariatric surgery compared with women with class III obesity who are managed conservatively. A reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia and congenital defects were observed.…”

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

“…In a recent Danish study, the average weight loss in premenopausal women during the first postoperative year was 39.6 kg (102). Pregnancy should be avoided within 2 years after bariatric surgery and young fertile women should use safe birth control (103). Performing OGTT after bariatric surgery can trigger dumping syndromes and is generally not recommended (104).…”

Management of Pregnant Women after Bariatric Surgery

“…In general, bariatric procedures should not be regarded as a contraindication to deliver naturally [ 19 , 28 ]. Nevertheless, increased rates of C-section in operated women are reported with some recent publications showing no differences [ 28 ].…”

“…In general, bariatric procedures should not be regarded as a contraindication to deliver naturally [ 19 , 28 ]. Nevertheless, increased rates of C-section in operated women are reported with some recent publications showing no differences [ 28 ]. However, huge variations in C-section rates were found in the literature ranging from about 18 to 60% section rate in operated women compared with 14–29% in control groups [ 28 ].…”