Nutritional and perinatal outcomes of pregnant women with a history of bariatric surgery: a case series from a UK centre

Breastfeeding in metabolic and bariatric patients: a comprehensive guide for surgeons, patients, and the multidisciplinary team

Since nearly 40% of metabolic and bariatric surgery (MBS) patients are individuals with the ability to bear children, many may seek to become pregnant or may be currently lactating when seeking surgery. While many patients plan to breastfeed, MBS patients are at high risk for premature cessation of breastfeeding. Limited literature exists on the impact of MBS on lactation and there are no established guidelines to help clinicians support and educate MBS patients about breastfeeding. Herein, we aim to fill that gap by providing a comprehensive guide for bariatric surgeons, obstetricians, women's health providers, lactation consultants, registered dietitians, bariatric nurse coordinators, and advanced practice providers to support breastfeeding in patients with a history of MBS or who are considering MBS. We review physician-patient discussion points on how MBS impacts lactation, the micronutrient and caloric needs for this unique population, and data to support successful breastfeeding in post-MBS patients who are lactating regarding practical, anesthetic, and imaging considerations.

Tackling the dual burden of malnutrition in pregnancy - pregnancy after weight loss surgery

The dual burden of malnutrition is characterised by the coexistence of undernutrition alongside overweight/obesity and diet-related noncommunicable diseases. It is a paradox which disproportionately affects women and is applicable to those who become pregnant after weight loss surgery. Obesity before and during pregnancy is associated with increased risk of adverse perinatal outcomes in both mother and child. Overall lifestyle interventions targeting weight loss in the preconception period have not proven effective, with people, and women in particular, increasingly seeking weight loss surgery. In women with severe obesity, surgery may normalise hormonal abnormalities and improve fertility. In those who become pregnant after surgery, evidence suggests a better overall obstetric outcome compared to those with severe obesity managed conservatively; however, there is heightened risk of maternal nutritional deficiencies and infants born small for gestational age. Specifically, pregnancy soon after surgery, in the catabolic phase when rapid weight loss is occurring, has the potential for poor outcomes. Lifelong micronutrient supplementation is required, and there is considerable risk of malnutrition if nutritional aftercare guidelines are not adhered to. It is therefore recommended that pregnancy is delayed until a stable weight is achieved and is supported by individualised advice from a multidisciplinary team. Further research is required to better understand how weight loss surgery affects the chances of having a healthy pregnancy and to ultimately improve nutritional management and patient care. In this review, we aim to summarise the evidence and guidance around nutrition during pregnancy after weight loss surgery.

Early life programming of health and disease: the long-term consequences of obesity in pregnancy: a narrative review

The prevalence of overweight and obesity is rising in all parts of the world and among young women it presents a very clear danger during pregnancy. Women who are overweight or who gain excessive weight during pregnancy are at greater risk of complications in pregnancy and labour, and are more likely to lose their child to stillbirth, or themselves die during pregnancy. This narrative review considers the evidence that in addition to increasing risk of poor pregnancy outcomes, obesity has the capacity to programme fetuses to be at greater risk of cardiometabolic disorders later in life. An extensive body of evidence from prospective and retrospective cohorts, and record linkage studies demonstrates associations of maternal obesity and/or gestational diabetes with cardiovascular disease, type-1 and type-2 diabetes. Studies in animals suggest that these associations are underpinned by adaptations that occur in fetal life, which remodel the structures of major organs including the brain, kidney and pancreas. This article is protected by copyright. All rights reserved.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m^–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m^–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Overweight and obesity before pregnancy and excessive gestational weight gain are major determinants of risk for pregnancy loss, gestational diabetes, hypertensive conditions, labour complications and maternal death.

Pregnancy is regarded as a teachable moment when women are at their most receptive to messages about their health. However, unclear guidance on diet and physical activity, weight stigma from health professionals, inexperience and reluctance among professionals about raising issues about weight, and stretched resources put the health of women and babies at risk.

Excessive weight gain in pregnancy and post‐partum weight retention compromise future fertility and increase risk for future pregnancies.

Large randomised controlled trials have had little success in addressing excessive gestational weight gain or antenatal complications. Individualised, culturally sensitive and responsive interventions appear to have greater success.