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.
Highlights
There is a dramatic increase in overweight and obesity worldwide
Vitamin D, calcium and bone metabolism Several studies have examined the relationship between post-Bariatric surgery (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]
We found that women after gastric bypass had improved fasting glucose, but altered patterns of postprandial glucose dynamics including a rise at 60 min, followed by hypoglycemia at 120 min in more than half of pregnant patients [28]
Summary
There is a dramatic increase in overweight and obesity worldwide. The WHO estimates that 39% of adults worldwide are overweight (BMI ≥ 25 kg/m2) and 13% are obese (BMI ≥30 kg/m2) [1]. The American Association of Clinical Endocrinologists recommends pre-operative and annual screening for Vitamin B12 deficiency in patients after malabsorptive and combined bariatric procedures and a supplementation of 1,000 μg/day orally or 500 μg/week intranasally or 1,000 μg/month parenterally [60]. There is only little evidence for detrimental effects of maternal protein deficiency on pregnancy outcome, mainly impaired fetal growth [84]; pregnant women after BS should be advised to adhere to the general recommendations for post-surgery protein intake and the fetal growth should be assessed regularly [23, 24]. Because of the limited number of participants in the available studies, no practical guidelines containing thresholds or dosage recommendations for the treatment of micronutrients deficiencies in post-surgical pregnancies have been created so far [51], all available statement papers recommend the supplementation of vitamins in pregnant women after BS [23, 24, 35, 61]. The rapid emptying of hyperosmolar carbohydrates into the small intestine leads to a fluid shift from plasma to bowel, causing a drop in blood pressure and subsequent compensation, leading to
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