No abstract

Purpose Current guidelines recommend to avoid pregnancy for 12–24 months after bariatric surgery because of active weight loss and an increased risk of nutritional deficiencies. However, high-quality evidence is lacking, and only a few studies included data on gestational weight gain. We therefore evaluated pregnancy and neonatal outcomes by both surgery-to-conception interval and gestational weight gain. Materials and Methods A multicenter retrospective analysis of 196 singleton pregnancies following Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was conducted. Pregnancies were divided into the early group (≤ 12 months), the middle group (12–24 months), and the late group (> 24 months) according to the surgery-to-conception interval. Gestational weight gain was classified as inadequate, adequate, or excessive according to the National Academy of Medicine recommendations. Results Pregnancy in the early group (23.5%) was associated with lower gestational age at delivery (267.1 ± 19.9 days vs 272.7 ± 9.2 and 273.1 ± 13.5 days, P = 0.029), lower gestational weight gain (− 0.9 ± 11.0 kg vs + 10.2 ± 5.6 and + 10.0 ± 6.4 kg, P < 0.001), and lower neonatal birth weight (2979 ± 470 g vs 3161 ± 481 and 3211 ± 465 g, P = 0.008) than pregnancy in the middle and late group. Inadequate gestational weight gain (40.6%) was associated with lower gestational age at delivery (266.5 ± 20.2 days vs 273.8 ± 8.4 days, P = 0.002) and lower neonatal birth weight (3061 ± 511 g vs 3217 ± 479 g, P = 0.053) compared to adequate weight gain. Preterm births were also more frequently observed in this group (15.9% vs 6.0%, P = 0.037). Conclusion Our findings support the recommendation to avoid pregnancy for 12 months after bariatric surgery. Specific attention is needed on achieving adequate gestational weight gain.

Objective: Formerly preeclamptic women with low plasma volume are at increased risk of recurrent gestational hypertensive disease. We hypothesized that a 4-week cycling training in formerly preeclamptic women improves (venous) hemodynamic function. Methods: In 9 formerly preeclamptic women, we examined physical fitness and hemodynamic function, before and after the training.We assessed blood pressure, heart rate, cardiac output, plasma volume, and calf and forearm venous compliance. Results: After the training, baseline blood pressure and cardiac output remained unchanged, but resting heart rate decreased (-7%, P ¼ .02). Plasma volume was 8% higher after training (P ¼ .01). Calf venous compliance increased (þ18%, P ¼ .02) but not forearm venous compliance (þ14%, P ¼ .09). Conclusion: Cycling training improves venous vascular function in formerly preeclamptic women. The decreased resting heart rate and improvement of venous compliance suggest reduced sympathetic activity. These rapid exercise-induced changes may improve maternal vascular adaptation in early pregnancy and with it the risk of (recurrent) gestational hypertensive disease.

The sympathoinhibitory response to volume expansion is diminished in low plasma volume, which suggests that cardiovascular reflex function is impaired. We speculate that this defect contributes to circulatory maladaptation to pregnancy, sympathetic dominance, and the development of gestational hypertensive disease.

LPV decreases the capacity to cope with head-up tilt without affecting the response pattern, suggesting reduced VRC.