Bariatric surgery and the risk of congenital anomalies in subsequent pregnancies

Auger, Nathalie; Bilodeau-Bertrand, Marianne; Tith, Rasmi M; Arbour, Laura

doi:10.1093/ajcn/nqz195

Cited by 17 publications

(9 citation statements)

References 30 publications

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“…After exact matching, Neovius et al (2019) found a decreased relative risk for major congenital defects (RR 0.67, 95% CI 0.52–0.87, P = 0.002). The other articles found no significant association between bariatric surgery and the incidence of congenital malformations ( Sheiner et al , 2004 , 2006 ; Josefsson et al , 2013 ; Parent et al , 2017 ; Auger et al , 2019 ).…”

Section: Resultsmentioning

confidence: 89%

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Snoek

Steegers‐Theunissen

Hazebroek

et al. 2021

Human Reproduction Update

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BACKGROUND Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically. OBJECTIVE AND RATIONALE The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations. SEARCH METHODS Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. Abstracts, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies. OUTCOMES A total of 51 articles were analysed. The mean quality score was 5 (range 2–8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) −0.24, 95% confidence interval (CI) −0.42, −0.05) and menstrual cycle irregularities (RD −0.24, 95% CI −0.34, −0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI −0.09, 0.10) and congenital malformations (RD 0.01, 95% CI −0.02, 0.03). WIDER IMPLICATIONS The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.

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Section: Resultsmentioning

confidence: 89%

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Snoek

Steegers‐Theunissen

Hazebroek

et al. 2021

Human Reproduction Update

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“…We classified heart defects as critical (tetralogy of Fallot, coarctation of the aorta, transposition of great vessels, truncus arteriosus, hypoplastic left heart, common ventricle, other) or noncritical (atrial septal defect, ventricular septal defect, endocardial cushion defect, pulmonary artery defects, heterotaxy, other). 25 Critical defects require urgent intervention at birth and may cause severe sequalae or death if not treated promptly. 26 …”

Section: Methodsmentioning

confidence: 99%

Association between First Trimester Exposure to Ambient PM2.5 and NO2 and Congenital Heart Defects: A Population-Based Cohort Study of 1,342,198 Live Births in Canada

Buteau

Veira

Bilodeau-Bertrand

et al. 2023

Environ Health Perspect

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Background: The extent to which ambient air pollution contributes to the pathogenesis of congenital heart defects remains uncertain. Objective: We investigated whether first trimester exposure to ambient fine particulate matter ( ) and nitrogen dioxide ( ) was associated with the risk of critical and noncritical heart defects in a large population-based cohort of births. Methods: We carried out a retrospective cohort study of children conceived between 2000 and 2016 in Quebec, Canada. Heart defects were identified via data from the Maintenance and Use of Data for the Study of Hospital Clientele registry. The main exposures were average concentration of and in a ) the first trimester and b ) the month of conception. Exposures were estimated at the residential postal code. Associations with critical and noncritical heart defects were assessed using logistic regression models, adjusted for maternal and infant characteristics. We considered single- and two-pollutant models and assessed modifying effects of maternal comorbidity, including preexisting hypertension, preeclampsia, anemia, and diabetes. Results: The cohort comprised 1,342,198 newborns, including 12,715 with heart defects. Exposure in the first trimester and month of conception yielded similar results; both were associated with a greater risk of heart defects. Adjusted odds ratios (OR) for any heart defect per interquartile range increase were 1.02 (95% CI: 1.00, 1.05) for and 1.10 (95% CI: 1.07, 1.13) for . Associations with atrial septal defects were 1.08 (95% CI: 1.03, 1.14) for and 1.19 (95% CI: 1.12, 1.25) for . Corresponding ORs for ventricular septal defects and individual critical heart defects were not significant. ( ; 95% CI: 1.06, 1.17) and ( ; 95% CI: 1.17, 1.31) exposure were associated with a greater risk of heart defects in mothers with comorbidity. Discussion: In this population-based cohort, prenatal exposure to ambient air pollution during the first trimester was associated with an increased risk of heart defects, particularly atrial septal defects. The association with heart defects was greater in mothers with comorbidity. https://doi.org/10.1289/EHP11120

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“…FA supplementation helps to reduce circulating Hcy levels in patients taking antiepileptic drugs [ 68 ]. It is also used regularly to combat folate deficiency anemia resulting from the excessive intake of alcoholic beverages, post-bariatric surgery [ 69 ], and in conjunction with methotrexate in rheumatoid arthritis [ 70 ].…”

Section: Folate Malabsorptionmentioning

confidence: 99%

Folic Acid, Folinic Acid, 5 Methyl TetraHydroFolate Supplementation for Mutations That Affect Epigenesis through the Folate and One-Carbon Cycles

Ménézo¹,

Elder

Clément³

et al. 2022

Biomolecules

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Methylation is an essential biochemical mechanism that is central to the transmission of life, and crucially responsible for regulating gametogenesis and continued embryo development. The methylation of DNA and histones drives cell division and regulation of gene expression through epigenesis and imprinting. Brain development and its maturation also depend on correct lipid methylation, and continued neuronal function depends on biogenic amines that require methylation for their synthesis. All methylation processes are carried out via a methyltransferase enzyme and its unique co-factor S-adenosylmethionine (SAM); the transfer of a methyl group to a target molecule results in the release of SAH (SA homocysteine), and then homocysteine (Hcy). Both of these molecules are toxic, inhibiting methylation in a variety of ways, and Hcy recycling to methionine is imperative; this is achieved via the one carbon cycle, supported by the folates cycle. Folate deficiency causes hyperhomocysteinaemia, with several associated diseases; during early pregnancy, deficiency interferes with closure of the neural tube at the fourth week of gestation, and nutraceutical supplementation has been routinely prescribed to prevent neural tube defects, mainly involving B vitamins, Zn and folates. The two metabolic pathways are subject to single nucleotide polymorphisms that alter their activity/capacity, often severely, impairing specific physiological functions including fertility, brain and cardiac function. The impact of three types of nutraceutical supplements, folic acid (FA), folinic acid (FLA) and 5 Methyl THF (MTHF), will be discussed here, with their positive effects alongside potentially hazardous secondary effects. The issue surrounding FA and its association with UMFA (unmetabolized folic acid) syndrome is now a matter of concern, as UMFA is currently found in the umbilical cord of the fetus, and even in infants’ blood. We will discuss its putative role in influencing the acquisition of epigenetic marks in the germline, acquired during embryogenesis, as well as the role of FA in the management of cancerous disease.

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Bariatric surgery and the risk of congenital anomalies in subsequent pregnancies

Cited by 17 publications

References 30 publications

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Association between First Trimester Exposure to Ambient PM2.5 and NO2 and Congenital Heart Defects: A Population-Based Cohort Study of 1,342,198 Live Births in Canada

Folic Acid, Folinic Acid, 5 Methyl TetraHydroFolate Supplementation for Mutations That Affect Epigenesis through the Folate and One-Carbon Cycles

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