Abstract
Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12–24 months to reduce the potential risk of intrauterine growth retardation. Dumping syndromes are common after bariatric surgery and can present diagnostic and therapeutic challenges in pregnancy. Early dumping occurs due to osmotic fluid shifts resulting from rapid gastrointestinal food transit, whilst late dumping is characterized by a hyperinsulinemic response to rapid absorption of simple carbohydrates. Dietary measures are the mainstay of management of dumping syndromes but pharmacotherapy may sometimes become necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize the nutritional status of women prior to and during pregnancy. Dietary management should include adequate protein and calorie intake and supplementation of vitamins and micronutrients. A high clinical index of suspicion is required for early diagnosis of surgical complications of prior weight loss procedures during pregnancy, including small bowel obstruction, internal hernias, gastric band erosion or migration and cholelithiasis.
Highlights
Obesity affects a quarter of all adult women in Western Europe and Canada, and a third in the USA [1]
This study reported a lower likelihood of gestational diabetes, hypertension and macrosomia following bariatric surgery but increased odds of offspring being small for gestational age; rates of caesarean section, postpartum haemorrhage and preterm delivery were not significantly different between the two groups
It is important to optimize the nutritional status of women prior to and following bariatric surgery [2, 38]
Summary
Obesity affects a quarter of all adult women in Western Europe and Canada, and a third in the USA [1]. Whereas lifestyle and dietary measures and anti-obesity pharmacotherapy are recommended as the primary treatment approach for obesity, bariatric surgery remains the most clinically effective and cost-effective intervention for people with morbid obesity [6, 7]. The global uptake of bariatric surgery has increased exponentially in the past decade [8, 9], including in women of childbearing age [10]. Pregnancy following bariatric surgery is increasingly encountered in clinical practice. These clinical presentations pose surgical, medical and obstetric challenges [2, 11, 12] requiring multidisciplinary team management. We discuss management of common complications of bariatric surgery that may be seen in pregnancy
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