Abstract
Post-bariatric weight loss can cause iatrogenic malnutrition and micronutrient depletion. In this study, we evaluated the impact of gastric bypass surgery (GB) and multivitamin supplement use on maternal micronutrient status before and across pregnancy. A retrospective medical chart review of 197 singleton pregnancies after GB with a due date between 2009 and 2019 was performed at a bariatric expertise center in the Netherlands. Hemoglobin, calcium, iron status, folate, vitamin D, vitamin B12 and ferritin levels were determined before and after GB during standard follow-up and at all gestational trimesters and analyzed using linear mixed models. Patients were prescribed standard multivitamin supplements or multivitamins specifically developed for post-bariatric patients (FitForMe WLS Forte (FFM)). Overall, hemoglobin and calcium levels decreased after surgery and during pregnancy, whereas folate, vitamin D, and vitamin B12 levels increased, and iron levels remained stable. FFM use was associated with higher hemoglobin, folate, vitamin D, and ferritin levels. In conclusion, through adequate supplementation and follow-up, GB does not have to result in impaired micronutrient status. Supplements developed specifically for post-bariatric patients generally result in higher micronutrient values than regular multivitamins before and during pregnancy. These data emphasize the urgent need for nutritional counseling including dietary and multivitamin supplement advise for post-bariatric women contemplating and during pregnancy.
Highlights
IntroductionThe global obesity incidence has reached pandemic proportions, and its related morbidity and mortality places a heavy burden on society and individuals, including women of reproductive age
Before surgery was 43.3 kg/m2 (IQR 40.9–46.2), which decreased to 29.0 kg/m2
This study aimed to investigate the course of maternal micronutrient status preconceptionally and during pregnancy in women after gastric bypass surgery
Summary
The global obesity incidence has reached pandemic proportions, and its related morbidity and mortality places a heavy burden on society and individuals, including women of reproductive age. The best solution to diminish obesity is adopting healthier nutritional behaviors in combination with a healthy lifestyle to accomplish weight loss. Bariatric surgery (BS) is envisioned as a durable solution for severe obesity as it leads to substantial and permanent weight loss. Patients qualify for this treatment if they have a body mass index (BMI) above 40 kg/m2 or a BMI above 35 kg/m2 with obesity-related comorbidities such as hypertension [2]. Obesity rates are similar between men and women, 73.7% of post-bariatric patients are female, of which most are of reproductive age [3,4]
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