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Chung Y, Cho I, Choi YS, Kim YM, Lee Y, Park SH, Jung MR, Kwon IG, Kim J, Lee SE, Kim J, Kong SH, Seo KW, Choi SI, Kim JH, Ha TK, Kim JJ, Park YS, Yoo MW, Kim DJ, Park JY, Yoo HM, Lee HJ, Kim SH, Lee HH, Park DJ, Park S, Han SM, Kim YJ, Park JM, Ryu SW, Lee SK, Park JY, Kim JW, on behalf of the Guidelines Committee of the Korean Society for Metabolic and Bariatric Surgery. The Korean Society for Metabolic and Bariatric Surgery (KSMBS) Position Statement on Female Candidates of Reproductive Age for Metabolic Bariatric Surgery. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2025; 14:1-23. [PMID: 40351820 PMCID: PMC12059304 DOI: 10.17476/jmbs.2025.14.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 04/19/2025] [Accepted: 04/19/2025] [Indexed: 05/14/2025]
Abstract
Obesity has emerged as a major global health issue. The ratio of male to female patients undergoing metabolic bariatric surgery (MBS) is 1:3.5. Although not as dramatic compared to the global trend, the rate of obesity in women of reproductive age in Korea has been steadily increasing over the past several decades. The impact of obesity on reproductive health and perinatal outcomes should be carefully considered when consulting female candidates of reproductive age for MBS. Obesity adversely affects reproductive health by causing menstrual irregularities, anovulation, subfertility, and increased miscarriage risk, as well as impairing the success of assisted reproductive technologies. Maternal obesity also heightens the risk of adverse perinatal outcomes, including childhood obesity and metabolic disorders. MBS has been shown to improve fertility outcomes and reduce obesity-related pregnancy complications, although concerns remain regarding potential risks such as small-for-gestational-age infants due to rapid weight loss and nutritional deficiencies. Despite these implications, current MBS guidelines rarely address the unique needs of reproductive-age women. In response, the Korean Society for Metabolic and Bariatric Surgery convened a task force to develop evidence-based recommendations tailored to this population. This position statement aims to guide the management of obesity in women of reproductive age to optimize reproductive and perinatal outcomes.
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Affiliation(s)
- Yoona Chung
- Metabolic and Bariatric Surgery Center, Department of Surgery, H+ Yangji Hospital, Seoul, Korea
| | - In Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yun Suk Choi
- Department of Surgery, Inha University Hospital, Incheon, Korea
| | - Yoo Min Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoontaek Lee
- Department of Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Shin-Hoo Park
- Division of Gastrointestinal Surgery, Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - In Gyu Kwon
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | | | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jong-Han Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae Kyung Ha
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Korea
| | - Moon-won Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Han Mo Yoo
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sang-Moon Han
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Yong Jin Kim
- Metabolic and Bariatric Surgery Center, Department of Surgery, H+ Yangji Hospital, Seoul, Korea
| | - Joong-Min Park
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Seung-Wan Ryu
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang Kuon Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Korea
| | - Jong Won Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Bechensteen BT, Sithiravel C, Strøm-Roum EM, Ruud HK, Kravdal G, Winther JA, Valderhaug TG. Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study. BMC Pregnancy Childbirth 2024; 24:229. [PMID: 38566061 PMCID: PMC10985986 DOI: 10.1186/s12884-024-06407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Maternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy. METHODS In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5). RESULTS The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030). CONCLUSION Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.
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Affiliation(s)
- Brit Torunn Bechensteen
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Cindhya Sithiravel
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | | | - Heidi Kathrine Ruud
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Gunnhild Kravdal
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | - Jacob A Winther
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
| | - Tone G Valderhaug
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway.
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Navaee M, Kashanian M, Kabir A, Zamaninour N, Chamari M, Pazouki A. Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort. Reprod Health 2024; 21:8. [PMID: 38233940 PMCID: PMC10795358 DOI: 10.1186/s12978-023-01736-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery. METHODS In this study Pregnant women (< 14 weeks' gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters. DISCUSSION By assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes.
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Affiliation(s)
- Maryam Navaee
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Kashanian
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Negar Zamaninour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Chamari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
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Berk R, Lima DL, Steinberger M, Viscarret V, Seu R, Konovalova V, Camacho D. The Influence of Pregnancy on Weight Loss After Previous Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2023; 33:975-979. [PMID: 37733301 DOI: 10.1089/lap.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Introduction: Bariatric surgery is routinely performed on obese women of reproductive age, most commonly with the laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass procedures (RYGB). This study analyzes the effects of postoperative pregnancy on excess BMI loss percentage (EBMIL%) after SG and RYGB. Methods: A retrospective study was conducted with 191 female patients of reproductive age between 20 and 40 years who underwent SG and RYGB performed at our institution between January 2017 and December 2018. A comparison of the results at 4-year follow-up was performed between patients who became pregnant after bariatric surgery with patients who did not. Results: Among 191 total cases, 32 (16.7%) patients became pregnant within a 4-year follow-up period, and 159 (83.2%) patients did not. The median postoperative body mass index (BMI) in the pregnant group was 33.3 kg/m2 (interquartile range [IQR] 30.1-38.5) and 33.5 kg/m2 (IQR 28.9-38.6) in the nonpregnant group. The mean EBMIL% within a 4-year follow-up in the pregnant group was 50.4% (standard deviation [SD] 23.5) and 55.5% (SD 30.4) in the nonpregnant group. The median weight before surgery in the pregnant group was 112 kg (IQR 107.9-132.2) and 117 kg (IQR 106-132.5) in the nonpregnant group. The median weight after surgery in the pregnant group was 89.5 kg (IQR 79.5-111) and 88.9 kg (IQR 78-103) in the nonpregnant group. There was no significant difference between outcomes. Conclusion: Weight loss maintenance after bariatric surgery is not impacted by postoperative pregnancy within a 4-year follow-up after SG and RYGB.
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Affiliation(s)
- Robin Berk
- Department of Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, Bronx, New York, USA
| | | | | | - Rie Seu
- Department of Surgery, Montefiore Medical Center, Bronx, New York, USA
| | | | - Diego Camacho
- Department of Surgery, Montefiore Medical Center, Bronx, New York, USA
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Alamri SH, Abdeen GN. Maternal Nutritional Status and Pregnancy Outcomes Post-bariatric Surgery. Obes Surg 2022; 32:1325-1340. [PMID: 35165854 PMCID: PMC8933294 DOI: 10.1007/s11695-021-05822-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Obesity in childbearing women leads to pregnancy-related complications such as gestational diabetes mellitus, pregnancy-associated hypertensive disorders, and macrosomia. Weight loss helps reduce these complications. Studies show bariatric surgery reduces obesity-related complications during and after pregnancy. However, bariatric surgery might be associated with adverse outcomes, such as low birth weight and small-for-gestational-age infants. In addition, several studies suggest pregnancy occurring less than a year post-bariatric surgery adversely affects pregnancy outcomes and causes micronutrients deficiency since the dramatic weight loss occurs in the first year. These adverse outcomes may lead to nutritional malabsorption, such as anemia and low vitamin B12 and folic acid levels. The review aims to overview obesity-related complications during pregnancy and the benefits and risks of bariatric surgery on pregnancy outcomes and maternal nutrition status.
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Affiliation(s)
- Sara H Alamri
- Department of Community Health Science, Clinical Nutrition, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Clinical Nutrition Services, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ghalia N Abdeen
- Department of Community Health Science, Clinical Nutrition, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia. .,Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Alolayan H, Aldubayyan A, Aldhohayan A, AlBassam R, Almarzuqi S, Almoqaiteb T, Almutlaq G, Alquwayfili L. General Public Awareness about the Indications and Complications of Sleeve Gastrectomy in Qassim Region, Saudi Arabia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Sleeve gastrectomy has become prevalent worldwide regardless of the patient’s awareness about the indications and complications. That would affect their judgment and decision.
AIM: This study aimed to assess the level of awareness about indications and complications of sleeve gastrectomy in the general public at Al-Qassim, Saudi Arabia in 2021.
MATERIALS AND METHODS: This is a quantitative cross-sectional study conducted among the general public living in the Qassim region, Saudi Arabia. Using a convenience sampling technique to select the participants as a representative sample for the general population. The target population will include all Saudis, who live in Al-Qassim and aged above 18 years, and will exclude who does not live in al-Qassim, age under 18 years, non-Saudi, who does not complete the questionnaire and who refuse to participate. The data were collected using a validated self-administered questionnaire. Questionnaires include; demographic characteristics, general awareness about sleeve gastrectomy, and awareness toward the indication and complication of sleeve gastrectomy. All statistical analyses were performed using Statistical Packages for Software Sciences version 26.
RESULTS: A total of 1091 respondents took part. The mean age of the respondents was 37.5 (SD 12.9) years old with females dominating the males (87.8% vs. 12.2%). Awareness about the indications and complications of sleeve gastrectomy constitutes 49% and 82.4%, respectively. In univariate analyses, those who have heard about body mass index (BMI) had greater knowledge of the indications and complications of sleeve gastrectomy. In a multivariate regression model, gender female was the independent significant predictor of sleeve gastrectomy complications whereas those who heard of BMI was the independent significant predictor of the knowledge toward the indications and complications of sleeve gastrectomy.
CONCLUSION: The general public demonstrated a lack of knowledge regarding the indications of sleeve gastrectomy but their knowledge about complications was better. Better knowledge about BMI comes with a better awareness of the indications and complications of sleeve gastrectomy.
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Micronutrient supplementation in pregnancies following bariatric surgery: a practical review for clinicians. Obes Surg 2021; 31:4542-4554. [PMID: 34304377 DOI: 10.1007/s11695-021-05546-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
Patients who have undergone bariatric surgery are at high risk for nutritional deficiencies before and after surgery if no proper supplementation and close follow-up are maintained. As pregnancies after these surgeries are occurring more frequently, deficiencies imply risks for both mother and child. Nutritional needs for this specific population are different from that of patients with obesity or a non-bariatric population. This review provides a comprehensive summary of the most described vitamins and minerals during pregnancy, after bariatric surgery, and during pregnancy after bariatric surgery in order to summarize their specific needs and possible side effects and to provide a useful guideline to the involved caregivers.
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Al Mansoori A, Shakoor H, Ali HI, Feehan J, Al Dhaheri AS, Cheikh Ismail L, Bosevski M, Apostolopoulos V, Stojanovska L. The Effects of Bariatric Surgery on Vitamin B Status and Mental Health. Nutrients 2021; 13:1383. [PMID: 33923999 PMCID: PMC8073305 DOI: 10.3390/nu13041383] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
Diet is a modifiable factor that ensures optimal growth, biochemical performance, improved mood and mental functioning. Lack of nutrients, notably vitamin B, has an impact on human health and wellbeing. The United Arab Emirates is facing a serious problem of micronutrient deficiencies because of the growing trend for bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy. People undergoing bariatric surgery are at high risk of developing neurological, cognitive, and mental disabilities and cardiovascular disease due to deficiency in vitamin B. Vitamin B is involved in neurotransmitter synthesis, including γ-aminobutyric acid, serotonin, dopamine, and noradrenaline. Deficiency of vitamin B increases the risk of depression, anxiety, dementia and Alzheimer's disease. In addition, vitamin B deficiency can disrupt the methylation of homocysteine, leading to hyperhomocysteinemia. Elevated homocysteine levels are detrimental to human health. Vitamin B deficiency also suppresses immune function, increases the production of pro-inflammatory cytokines and upregulates NF-κB. Considering the important functions of vitamin B and the severe consequences associated with its deficiency following bariatric surgery, proper dietary intervention and administration of adequate supplements should be considered to prevent negative clinical outcomes.
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Affiliation(s)
- Amna Al Mansoori
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Hira Shakoor
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Jack Feehan
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC 8001, Australia
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Leila Cheikh Ismail
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX1 2JD, UK
| | - Marijan Bosevski
- Faculty of Medicine Skopje, University Clinic of Cardiology, University of Ss. Cyril and Methodius, 1010 Skopje, North Macedonia;
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
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Melendez-Araújo MS, Lemos KGE, Arruda SLM, Dutra ES, de Carvalho KMB. Weight Status of Brazilian's Mother-Son Dyad after Maternal Bariatric Surgery. Obes Surg 2020; 30:3508-3513. [PMID: 32314250 DOI: 10.1007/s11695-020-04605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pregnant women who have undergone bariatric surgery must be followed to ensure healthy mother-child nutritional status. This study aimed to compare weight status of mother-child dyad after maternal bariatric surgery in public and private Brazilian healthcare system units. MATERIALS AND METHODS This retrospective matched case-control included 19 women who underwent Roux-en-Y gastric bypass surgery performed by the same private clinical surgical team and 19 age- and preoperative body mass index (BMI) matched patients from a public hospital. All 38 female patients reported a postoperative spontaneous pregnancy. The T test of independent samples and Pearson chi-square test were used to investigate inter-group differences. RESULTS Patients in the private system were more frequently married (94.7% versus 68.4%, p = 0.036) and had a higher educational level (94.7% versus 36.8%, p = 0.01 for tertiary education) but lower BMI, compared with those in the public system (pre-gestational = 25.7 ± 3.2 versus 28.5 ± 5.0 kg/m2, p = 0.049; post-gestational = 24.6 ± 1.6 versus 29.0 ± 6.0 kg/m2, p = 0.040). The interval from bariatric surgery to conception was shorter among public system patients (21.1 ± 13.9 versus 43.4 ± 31.2 months, p = 0.009). In both groups, almost 90% of children were born at full term and with adequate weights. CONCLUSION Despite differences in the characteristics of public and private systems, the mother-child dyads in both groups achieved satisfactory post-bariatric surgery gestation outcomes. The type of medical system does not appear to influence pregnancy outcomes or neonatal weight status conditions.
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Affiliation(s)
- Mariana S Melendez-Araújo
- Graduate Program in Human Nutriton, Department of Nutrition, Faculty od Health Science, University of Brasília, Darcy Ribeiro University Campus, Asa Norte, Brasília, DF, 70910-900, Brazil
- Asa Norte Regional Hospital (HRAN), SMHN Qd 02, Asa Norte, Brasília, DF, 70710-100, Brazil
- Dr. Sérgio Arruda Clinic - Bariatric Surgery, SMHN Qd 02 Bloco C - Ed. Dr. Crispim, salas 1309-1313, Asa Norte, Brasília, DF, 70710-100, Brazil
| | - Kássia G E Lemos
- Graduate Program in Human Nutriton, Department of Nutrition, Faculty od Health Science, University of Brasília, Darcy Ribeiro University Campus, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Sérgio L M Arruda
- Asa Norte Regional Hospital (HRAN), SMHN Qd 02, Asa Norte, Brasília, DF, 70710-100, Brazil
- Dr. Sérgio Arruda Clinic - Bariatric Surgery, SMHN Qd 02 Bloco C - Ed. Dr. Crispim, salas 1309-1313, Asa Norte, Brasília, DF, 70710-100, Brazil
| | - Eliane S Dutra
- Graduate Program in Human Nutriton, Department of Nutrition, Faculty od Health Science, University of Brasília, Darcy Ribeiro University Campus, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Kênia Mara Baiocchi de Carvalho
- Graduate Program in Human Nutriton, Department of Nutrition, Faculty od Health Science, University of Brasília, Darcy Ribeiro University Campus, Asa Norte, Brasília, DF, 70910-900, Brazil.
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Sancak S, Çeler Ö, Çırak E, Karip AB, Tumiçin Aydın M, Esen Bulut N, Mahir Fersahoğlu M, Altun H, Memişoğlu K. Timing of Gestation After Laparoscopic Sleeve Gastrectomy (LSG): Does It Influence Obstetrical and Neonatal Outcomes of Pregnancies? Obes Surg 2020; 29:1498-1505. [PMID: 30661209 DOI: 10.1007/s11695-018-03700-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM We aimed to evaluate the effect of pregnancy timing after laparoscopic sleeve gastrectomy (LSG) on maternal and fetal outcomes. METHODS Women with LSG were stratified into two groups with surgery-to-conception intervals of ≤ 18 months (early group) or > 18 months (late group). Only the first delivery after LSG was included in this study. We compared maternal characteristics, pregnancy, and neonatal outcomes and adherence to the Institute of Medicine's (IOM) recommendations for gestational weight gain (GWG) in the two groups. RESULTS Fifteen patients conceived ≤ 18 months after surgery, with a mean surgery-to-conception interval of 5.6 ± 4.12 months, and 29 women conceived > 18 months following LSG, with a mean surgery-to-conception interval of 32.31 ± 11.38 months, p < 0.05. There was no statistically significant difference between the two groups regarding birth weight, gestational age, cesarean deliveries (CD), preterm birth, whether their child was small or large for their gestational age, or in the need of neonatal intensive care. There was no correlation between mean weight loss from operation till conception, mean weight gain during pregnancy, and mean body mass index (BMI) at conception between birth weight in either study group. Inadequate and normal GWG was significantly higher in the early group, whereas excessive GWG was significantly higher in the late group (X2, 20.780; p = < 0.001). CONCLUSION The interval between LSG and conception did not impact maternal and neonatal outcomes. Pregnancy after LSG was overall safe and well-tolerated.
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Affiliation(s)
- Seda Sancak
- Fatih Sultan Mehmet Education and Research Hospital, Endocrinology and Metabolism Disorders, Department of Internal Medicine, University of Health Sciences, Atasehir, 34752, İstanbul, Turkey.
| | - Özgen Çeler
- Fatih Sultan Mehmet Education and Research Hospital, Endocrinology and Metabolism Disorders, Department of Internal Medicine, University of Health Sciences, Atasehir, 34752, İstanbul, Turkey
| | - Elif Çırak
- Fatih Sultan Mehmet Education and Research Hospital, Department of Internal Medicine, University of Health Sciences, Atasehir, İstanbul, Turkey
| | - Aziz Bora Karip
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, Istanbul, Turkey
| | - M Tumiçin Aydın
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, Istanbul, Turkey
| | - M Mahir Fersahoğlu
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, Istanbul, Turkey
| | - Hasan Altun
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, Istanbul, Turkey
- General Surgery Clinic, Liv Hospital, Ulus, Istanbul, Turkey
| | - Kemal Memişoğlu
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, Istanbul, Turkey
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11
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Haseeb YA. A Review of Obstetrical Outcomes and Complications in Pregnant Women after Bariatric Surgery. Sultan Qaboos Univ Med J 2019; 19:e284-e290. [PMID: 31897311 PMCID: PMC6930040 DOI: 10.18295/squmj.2019.19.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/08/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery (BS) is a novel treatment for weight reduction with longer lasting health benefits. This review aimed to summarise the available evidence regarding the fetomaternal outcomes and the most common challenges and complications in pregnancies following BS. Google Scholar (Google LLC, Mountain View, California, USA) and PubMed® (National Library of Medicine, Bethesda, Maryland, USA) databases were searched for articles published until December 2018. A total of 64 articles were included in this review and results showed that BS mitigates the risk of gestational diabetes mellitus, hypertensive disorders in pregnancy and fetal macrosomia. However, it can also have detrimental effects on fetomaternal health. There is paucity of data regarding small for gestational age intrauterine growth restriction, premature rupture of membranes and long-term effects on the children born to women who underwent BS.
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Affiliation(s)
- Yasmeen A Haseeb
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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12
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Falcone V, Stopp T, Feichtinger M, Kiss H, Eppel W, Husslein PW, Prager G, Göbl CS. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth 2018; 18:507. [PMID: 30587161 PMCID: PMC6307154 DOI: 10.1186/s12884-018-2124-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
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.
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Affiliation(s)
- Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina Stopp
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Bariatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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13
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Stopp T, Falcone V, Feichtinger M, Göbl C. Fertility, Pregnancy and Lactation After Bariatric Surgery - a Consensus Statement from the OEGGG. Geburtshilfe Frauenheilkd 2018; 78:1207-1211. [PMID: 30655646 PMCID: PMC6294640 DOI: 10.1055/a-0706-7578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery is recommended when other weight loss interventions, such as lifestyle modification or medications, have failed. A considerable number of women undergoing bariatric surgery are of childbearing age; hence, it is necessary to be aware of the effects of bariatric surgery on pregnancy for managing these patients. Although bariatric surgery is associated with positive effects on cardiovascular and metabolic parameters, side effects such as anaemia, the risk of developing internal hernia, altered glucose metabolism and the risk of small for gestational age offspring have to be considered. Pregnant women with a history of gastric bypass should not undergo the oral glucose tolerance test (OGTT) due to the high risk of hypoglycaemia. There are no contraindications for vaginal delivery and breastfeeding. This paper has been published as a consensus statement by the Austrian Society of Gynaecology and Obstetrics (OEGGG).
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Affiliation(s)
- Tina Stopp
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | - Veronica Falcone
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | | | - Christian Göbl
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
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14
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Harreiter J, Schindler K, Bancher-Todesca D, Göbl C, Langer F, Prager G, Gessl A, Leutner M, Ludvik B, Luger A, Kautzky-Willer A, Krebs M. Management of Pregnant Women after Bariatric Surgery. J Obes 2018; 2018:4587064. [PMID: 29973985 PMCID: PMC6008727 DOI: 10.1155/2018/4587064] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/29/2018] [Indexed: 02/07/2023] Open
Abstract
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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Affiliation(s)
- Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Dagmar Bancher-Todesca
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christian Göbl
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Felix Langer
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Gerhard Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Alois Gessl
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Michael Leutner
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
- Medizinische Abteilung mit Endokrinologie, Diabetologie, Nephrologie, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
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15
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Carreau AM, Nadeau M, Marceau S, Marceau P, Weisnagel SJ. Pregnancy after Bariatric Surgery: Balancing Risks and Benefits. Can J Diabetes 2017; 41:432-438. [DOI: 10.1016/j.jcjd.2016.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/16/2016] [Accepted: 09/05/2016] [Indexed: 01/31/2023]
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16
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Abstract
The nutritional status of a woman during pregnancy and lactation is not only critical for her health but for future generations. Although a nutritionist or registered dietitian can help facilitate dietary counseling and interventions, physicians also need to be cognizant of nutritional needs during pregnancy because they differ significantly compared with nonpregnant populations. Furthermore, an individualized approach to nutritional counseling that considers a woman's nutritional status and body mass index is recommended.
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Affiliation(s)
- Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2175, Chicago, IL 60611, USA.
| | - Priya Rajan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2175, Chicago, IL 60611, USA
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17
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Jans G, Matthys C, Bel S, Ameye L, Lannoo M, Van der Schueren B, Dillemans B, Lemmens L, Saey JP, van Nieuwenhove Y, Grandjean P, De Becker B, Logghe H, Coppens M, Roelens K, Loccufier A, Verhaeghe J, Devlieger R. AURORA: bariatric surgery registration in women of reproductive age - a multicenter prospective cohort study. BMC Pregnancy Childbirth 2016; 16:195. [PMID: 27473473 PMCID: PMC4966861 DOI: 10.1186/s12884-016-0992-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 07/19/2016] [Indexed: 12/28/2022] Open
Abstract
Background The expansion of the obesity epidemic is accompanied with an increase in bariatric procedures, in particular in women of reproductive age. The weight loss induced by the surgery is believed to reverse the negative impact of overweight and obesity on female reproduction, however, research is limited to in particular retrospective cohort studies and a growing number of small case-series and case-(control) studies. Methods/design AURORA is a multicenter prospective cohort study. The main objective is to collect long-term data on reproductive outcomes before and after bariatric surgery and in a subsequent pregnancy. Women aged 18–45 years are invited to participate at 4 possible inclusion moments: 1) before surgery, 2) after surgery, 3) before 15 weeks of pregnancy and 4) in the immediate postpartum period (day 3–4). Depending on the time of inclusion, data are collected before surgery (T1), 3 weeks and 3, 6, 12 or x months after surgery (T2-T5) and during the first, second and third trimester of pregnancy (T6-T8), at delivery (T9) and 6 weeks and 6 months after delivery (T10-T11). Online questionnaires are send on the different measuring moments. Data are collected on contraception, menstrual cycle, sexuality, intention of becoming pregnant, diet, physical activity, lifestyle, psycho-social characteristics and dietary supplement intake. Fasting blood samples determine levels of vitamin A, D, E, K, B-1, B-12 and folate, albumin, total protein, coagulation parameters, magnesium, calcium, zinc and glucose. Participants are weighted every measuring moment. Fetal ultrasounds and pregnancy course and complications are reported every trimester of pregnancy. Breastfeeding is recorded and breast milk composition in the postpartum period is studied. Discussion AURORA is a multicenter prospective cohort study extensively monitoring women before undergoing bariatric surgery until a subsequent pregnancy and postpartum period. Trial registration Retrospectively registered (July 2015 - NCT02515214)
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Affiliation(s)
- Goele Jans
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Christophe Matthys
- Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sarah Bel
- Scientific Institute of Public Health, Department of Public Health and Surveillance, Unit Surveys, Lifestyle and Chronic Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Lieveke Ameye
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias Lannoo
- Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Bart Van der Schueren
- Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Bruno Dillemans
- Department of Abdominal Surgery, St-Jan Hospital Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Luc Lemmens
- Department of Abdominal Surgery, St-Nikolaas Hospital, Moerlandstraat 1, 9100, St-Niklaas, Belgium
| | - Jean-Pierre Saey
- Medicosurgical unit for metabolic diseases, CHR Mons Hainaut, 5 avenue Baudouin de Constantinople, 7000, Mons, Belgium
| | - Yves van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Pascale Grandjean
- Department of Obstetrics and Gynecology, CHR Mons Hainaut, 5 avenue Baudouin de Constantinople, 7000, Mons, Belgium
| | - Ben De Becker
- Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Oosterveldlaan 24, 2610, Wilrijk, Belgium
| | - Hilde Logghe
- Department of Obstetrics and Gynecology, St-Lucas Hospital Bruges, St-Lucaslaan 29, 8310, Bruges, Belgium
| | - Marc Coppens
- Department of Obstetrics and Gynecology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium
| | - Kristien Roelens
- Department of Obstetrics and Gynecology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Anne Loccufier
- Department of Obstetrics and Gynecology, St-Jan Hospital Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Johan Verhaeghe
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Roland Devlieger
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Oosterveldlaan 24, 2610, Wilrijk, Belgium.,Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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18
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Kumari A, Nigam A. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy. J Clin Diagn Res 2015; 9:QE01-5. [PMID: 26672514 DOI: 10.7860/jcdr/2015/14258.6802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/07/2015] [Indexed: 01/05/2023]
Abstract
Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed.
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Affiliation(s)
- Archana Kumari
- Assistant Professor, Department of Obstetrics and Gynaecology, Hamdard Institute of Medical sciences and Research , New Delhi, India
| | - Aruna Nigam
- Associate Professor, Department of Obstetrics and Gynaecology, Hamdard Institute of Medical sciences and Research , New Delhi, India
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19
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Jans G, Matthys C, Bogaerts A, Lannoo M, Verhaeghe J, Van der Schueren B, Devlieger R. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Adv Nutr 2015; 6:420-9. [PMID: 26178026 PMCID: PMC4496736 DOI: 10.3945/an.114.008086] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pregnant and postpartum women with a history of bariatric surgery are at risk of micronutrient deficiencies as a result of the combination of physiologic changes related to pregnancy and iatrogenic postoperative alterations in the absorption and metabolism of crucial nutrients. This systematic review investigates micronutrient deficiencies and related adverse clinical outcomes in pregnant and postpartum women after bariatric surgery. A systematic approach involving critical appraisal was conducted independently by 2 researchers to examine deficiencies of phylloquinone, folate, iron, calcium, zinc, magnesium, iodide, copper, and vitamins A, D, and B-12 in pregnant and postpartum women after bariatric surgery, together with subsequent outcomes in the neonates. The search identified 29 relevant cases and 8 cohort studies. The quality of reporting among the case reports was weak according to the criteria based on the CARE (CAse REporting) guidelines as was that for the cohort studies based on the criteria from the Cohort Study Quality Assessment list of the Dutch Cochrane Center. The most common adverse neonatal outcomes related to maternal micronutrient deficiencies include visual complications (vitamin A), intracranial hemorrhage (phylloquinone), neurological and developmental impairment (vitamin B-12), and neural tube defects (folate). On the basis of the systematically collected information, we conclude that the evidence on micronutrient deficiencies in pregnant and postpartum women after bariatric surgery and subsequent adverse neonatal outcomes remains weak and inconclusive.
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Affiliation(s)
- Goele Jans
- Departments of Development and Regeneration and
| | - Christophe Matthys
- Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium;,Departments of Endocrinology
| | - Annick Bogaerts
- University College Leuven, Hasselt, Belgium;,Center for Research and Innovation in Care, Department of Nursing and Midwifery Sciences, University of Antwerp, Antwerp, Belgium; and
| | - Matthias Lannoo
- Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium;,Abdominal Surgery, and
| | - Johan Verhaeghe
- Departments of Development and Regeneration and,Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium;,Departments of Endocrinology
| | - Roland Devlieger
- Departments of Development and Regeneration and Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproduction, GZA, Wilrijk, Belgium
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20
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Carlos Barrera H. Embarazo después de cirugía bariátrica. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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Pelizzo G, Calcaterra V, Fusillo M, Nakib G, Ierullo AM, Alfei A, Spinillo A, Stronati M, Cena H. Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects. Nutr J 2014; 13:59. [PMID: 24929556 PMCID: PMC4071151 DOI: 10.1186/1475-2891-13-59] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 06/06/2014] [Indexed: 02/07/2023] Open
Abstract
Objective Bariatric surgery results in decreased food intake and a variable degree of malabsorption. Without adequate supplementation, the most common complications of this surgery are nutritional disorders. Pregnancy following surgery for obesity is a particular condition requiring strict monitoring of nutrient intake necessary for fetal development and a favourable neonatal prognosis. Patients Malnutrition in pregnancy and congenital neural malformations are reported in three women who had previously undergone bariatric surgery (1, 5 and 18 years before pregnancy, respectively). Two patients underwent the Roux en Y bypass and one bilio-pancreatic diversion with gastroplasty. None of the three received pre-conceptional nutritional counselling. Patients 1 and 2 did not undergo postoperative nutritional surveillance; nutrient supplementation was started at 22 and 20 weeks gestation, respectively. In patient 3, supplementation was stopped at six weeks gestation. Results Newborns 1 and 2 presented with dorsal myelomeningocele and ventricular dilation. Both underwent surgery and a ventriculo-peritoneal shunt was inserted in the first month of life. Newborn 3 had microcephaly, bilateral microphthalmia and sensorineural deafness. Conclusions Diet and nutritional status, before and during pregnancy, play an important role in the early processes of fetal development and neonatal outcome. Women of childbearing age who have had bariatric surgery, should be encouraged to follow a well-balanced diet as part of a weight management strategy. They should be advised to take recommended maternal supplements.
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Affiliation(s)
- Gloria Pelizzo
- Department of Maternal and Children's Health, Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo and University of Pavia, P,le Golgi 2, Pavia 27100, Italy.
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