Vitamin D and its relation with ionic calcium, parathyroid hormone, maternal and neonatal characteristics in pregnancy after roux-en-Y gastric bypass

Medeiros, Marina; Matos, Andréa Cardoso de; Pereira, Sílvia; Saboya, Carlos; Ramalho, Andréa

doi:10.1007/s00404-015-3861-4

Cited by 19 publications

(15 citation statements)

References 37 publications

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“…Several studies have examined the relationship between post-BS pregnancy, calcium and vitamin D metabolism and found a Vitamin D deficiency in 3% to over 70% of pregnant women, depending on the BS procedure [51, 54, 70]. There is a physiological increase in the need of vitamin D and calcitriol during pregnancy seemingly related to the calcium transfer to the fetus, particularly in the last trimester [70].…”

Section: Challenges and Benefits Of Bariatric Surgery Before Pregnancymentioning

confidence: 99%

“…The prevalence of elevated PTH levels (> 65 pg/ml) was highest in the third trimester with 32.6% of subjects. However, no adverse pregnancy outcomes were detected [70]. A large retrospective study conducted in Taiwan pointed out that there is a high incidence of post-surgery secondary hyperparathyroidism for all procedures (37.2%) which could lead to a higher long-term fracture risk, however, the available data ins still controversial.…”

Section: Challenges and Benefits Of Bariatric Surgery Before Pregnancymentioning

confidence: 99%

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

Falcone

Stopp

Feichtinger

et al. 2018

BMC Pregnancy Childbirth

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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.

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Section: Challenges and Benefits Of Bariatric Surgery Before Pregnancymentioning

confidence: 99%

Section: Challenges and Benefits Of Bariatric Surgery Before Pregnancymentioning

confidence: 99%

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

Falcone

Stopp

Feichtinger

et al. 2018

BMC Pregnancy Childbirth

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“…Another study found significantly higher level folate serum levels after surgery and during pregnancy due to supplementation ( Mead et al , 2014 ). Medeiros et al (2016) found that 72% of women after RYGB had an inadequate vitamin D status during the first trimester despite daily vitamin D supplementation.…”

Section: Resultsmentioning

confidence: 99%

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Snoek

Steegers‐Theunissen

Hazebroek

et al. 2021

Human Reproduction Update

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BACKGROUND Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically. OBJECTIVE AND RATIONALE The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations. SEARCH METHODS Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. Abstracts, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies. OUTCOMES A total of 51 articles were analysed. The mean quality score was 5 (range 2–8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) −0.24, 95% confidence interval (CI) −0.42, −0.05) and menstrual cycle irregularities (RD −0.24, 95% CI −0.34, −0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI −0.09, 0.10) and congenital malformations (RD 0.01, 95% CI −0.02, 0.03). WIDER IMPLICATIONS The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.

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“…Higher calcium doses in pregnancies after bariatric surgery are recommended compared with normal pregnancies. Calcium deficiency was reported in 15.2% in the first and second trimesters and 20% in the third trimester in pregnant women after RYGB [ 72 ]. PTH excursions were found in 19.6, 30.4, and 32.6% from first to third trimester, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…In postbariatric populations, doses up to 6000 IU/d are discussed for nonpregnant women [ 6 ]. A study evaluating vitamin D status and its relations with ionic calcium and parathyroid hormone (PTH) in pregnant women after RYGB found vitamin D deficiency (≤20 ng/mL) or insufficiency (>20–30 ng/mL) above 70% in all trimesters [ 72 ]. Negative correlations between calcium and PTH as well as an association of vitamin D with higher risk of urinary tract infection were reported.…”

Section: Resultsmentioning

confidence: 99%

Management of Pregnant Women after Bariatric Surgery

et al. 2018

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The prevalence of obesity is growing worldwide, and strategies to overcome this epidemic need to be developed urgently. Bariatric surgery is a very effective treatment option to reduce excess weight and often performed in women of reproductive age. Weight loss influences fertility positively and can resolve hormonal imbalance. So far, guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12–24 months after surgery. As limited data of these suggestions exist, further evidence is urgently needed as well for weight gain in pregnancy. Oral glucose tolerance tests for the diagnosis of gestational diabetes mellitus (GDM) should not be performed after bariatric procedures due to potential hypoglycaemic adverse events and high variability of glucose levels after glucose load. This challenges the utility of the usual diagnostic criteria for GDM in accurate prediction of complications. Furthermore, recommendations on essential nutrient supplementation in pregnancy and lactation in women after bariatric surgery are scarce. In addition, nutritional deficiencies or daily intake recommendations in pregnant women after bariatric surgery are not well investigated. This review summarizes current evidence, proposes clinical recommendations in pregnant women after bariatric surgery, and highlights areas of lack of evidence and the resulting urgent need for more clinical investigations.

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Vitamin D and its relation with ionic calcium, parathyroid hormone, maternal and neonatal characteristics in pregnancy after roux-en-Y gastric bypass

Abstract: The post-RYGB pregnant women showed an elevated serum inadequacy (deficiency or insufficiency) of 25(OH)D during pregnancy. Maternal vitamin D status showed no association with maternal variables, except UTI, and the neonatal variables analyzed.

Cited by 19 publications

References 37 publications

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

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

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Management of Pregnant Women after Bariatric Surgery

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