A Prospective Study of Association of Micronutrients Deficiencies during Pregnancy and Neonatal Outcome among Women after Bariatric Surgery

Abstract

Little is known about the association of micronutrients deficiencies during pregnancy and neonatal outcome among women after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). We present a prospective study of 87 consecutive women with a history of RYGB (n = 37) or SG (n = 50) who underwent complete and regular clinical and biological nutritional assessments during pregnancy. Data on maternal characteristics, biological nutritional parameters, antenatal management, and perinatal outcome were collected. The objective was to evaluate serum levels of micronutrients at the second trimester, and to assess the association between micronutrients deficiencies and neonatal outcome. After RYGB, maternal age (34.3 ± 4.9 vs. 31.1 ± 4.6 years; p = 0.003) and pregnancy timing after surgery (64.5 ± 47.0 vs. 38.1 ± 28.1 months; p = 0.002) were significantly higher, and pre-pregnancy BMI was significantly lower (29.8 ± 5.6 vs. 32.9 ± 7.1 kg/m2; p = 0.03). Maternal and neonatal outcomes were similar. Additional supplementations after blood tests were similar in groups. Zinc, selenium, vitamins A1, B1, B6, C, and E levels were not different depending on the type of surgery. Zinc deficiency (7/87) was significantly more frequent after RYGP (18.9% vs. 0%; p = 0.02) and selenium deficiency (15/87) was similar in groups (21.6% after RYGB and 14.0% after SG; p = 0.36). The mean birth weight was significantly lower in selenium deficiency cases (3137 ± 550 vs. 3535 ± 737 g; p = 0.04). Selenium deficiency was negatively correlated with birth weight (r = −0.23; p = 0.03) and with birth weight z-score (r = −0.26; p = 0.01), but not correlated after adjustment for the procedure. The levels of micronutrients surveillance along pregnancy in women with a history of bariatric surgery is necessary to decrease the risk of inadequate fetal growth in the patients.

Medical and Psychological Aspects of Pregnancy in Women with Obesity and after Bariatric Surgery

“…-Deficiencies of vitamins and microelements, especially iron, vitamin B12, A, phylloquinone, and folic acid [75][76][77], as well as zinc, selenium, and vitamins A1, B1, B6, and C [78]; -Hormonal changes-an increase in the level of sex hormone binding globulins (SHBG), progesterone, and estradiol and a decrease in the level of androgens, androstenedione, and testosterone; LH and FSH remained unchanged; studies on anti-Mullerian hormone (AMH) are inconsistent [55,77]; -Improvement in the regularity of menstrual cycles and fertility [77]; -Lower risk of gestational diabetes [9,12,76,79,80] but a higher risk of hypoglycemia and hyperglycemia [81]; -Lower risk of gestational hypertension [9,12,76,79,80,82]; -Higher risk of anemia [9,76]; -Higher risk of fractures [9]; -No effect on gestational weight gain [83].…”

Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review

“…They found no cases of deficiency, no differences between the different techniques, and no effects on maternal and foetal outcomes [ 93 ]. In a prospective study in 87 women [ 179 ], zinc deficiency (<0.51 mg/L) was found in 8.0%, all after RYGB (18.9% vs. 0% in SG; p = 0.02), and preterm birth occurred in 100% of these cases. The usual multivitamins do not provide sufficient zinc for pregnancy after bariatric surgery, especially in the case of malabsorptive techniques.…”

“…Selenium serum levels were low in 77.8%, 22.2%, and 50.0% in the first, second, and third trimesters, respectively. In a prospective study in 87 women [ 179 ], selenium deficiency (<60 μg/L) was found in 17.2%: 21.6% after RYGB and 14.0% after SG ( p = 0.36). A selenium deficit in the second trimester in women with a history of BS was negatively correlated with birthweight and with birthweight z-score [ 179 ].…”

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

“…Protein, iron, folate, calcium, and vitamin B12 and D are the most common nutrient deficiencies after gastric bypass surgery, which may also have negative effects on the fetus [ 30 ]. The need for nutrients during pregnancy increases due to fetal growth, and a deficiency in any of them may increase the risk of fetal abnormalities, especially neural tube defects [ 31 ].…”