Bariatric surgery for women of reproductive age

Abstract

Please cite this paper as: Robson S, Daniels B, Rawlings L. Bariatric surgery for women of reproductive age. BJOG 2016;123:171-174. Australia is ranked fifth of all OECD countries for prevalence of obesity in women, 1 and the proportion of young women with obesity is increasing. Over the last decade the estimated prevalence has increased by about 60% in Australian women aged 25-34 years, and by a remarkable 80% in women aged 35-44 years. 2 In 2012 just over 20% of women giving birth in Australia had a body mass index (BMI) of 30 kg/m 2 or greater, and 3% had a BMI of 40 kg/m 2 or more. As the theme of this issue of BJOG attests, obesity has become perhaps the major challenge facing those who provide care to women who are pregnant or seeking to become pregnant in both the developed and, increasingly, the developing world. Obesity is important because it affects all phases of a woman's reproductive life -it makes achieving an ongoing pregnancy more difficult, increases the likelihood of things going wrong during pregnancy and birth, can have important long-term adverse effects for the offspring, and limits the ability of a woman to provide longer-term parental care to her children. For all of these reasons, finding ways to help reproductive-age women return to a healthy weight before they try to become pregnant should be a priority.Losing weight is difficult and while systematic reviews 3 have shown that behavioural treatments and pharmacological therapies, alone or in combination, can bring about weight loss and improve health, the magnitude of change is relatively modest (typically around 3 kg) and the duration of improvement is unclear, with few studies providing follow up for 10 years or more. Nonsurgical approaches to obesity are also resource-intensive and require life-long compliance. They are also least likely to work in adults with the greatest degree of obesity. For these reasons the introduction and subsequent evolution of surgical approaches to the management of obesity have sparked great interest. Bariatric surgical procedures had their genesis in the 1950s, when it was noted that resection and shortening of the small intestine resulted in subsequent malabsorption and weight loss. 4 There are two main types of procedure in common use: 'restrictive' procedures such as adjustable gastric banding and sleeve gastrectomy; and 'malabsorptive' procedures such as the Roux-en-Y gastric bypass or biliopancreatic diversion. Restrictive procedures are technically easier to perform, but adjustable gastric bands that encircle the more proximal portion of the stomach may require frequent adjustment. In addition, food of a soft consistency (ice cream, for example) can easily defeat the band. Malabsorptive procedures, as their name suggests, shorten the effective length of the small intestine and, by an effect at the proximal duodenum, probably alter neuroendocrine function in the gastrointestinal tract as well.Recent systematic review of the evidence for bariatric surgery in nonpregnant adults is very encouraging,...

Gravidez após cirurgia bariátrica: uma revisão bibliográfica

“…As cirurgias com mecanismo disabsortivo, possuem duas técnicas realizadas, o desvio jejunoileal e a derivação biliopancreática. Esses procedimentos são baseados em modelos que encurtam a superfície total de absorção através da redução da parte do intestino delgado, e como consequência promove menor absorção (ROBSON S, et al, 2015).…”

“…No entanto, esse modelo tem como possíveis complicações a ocorrência de fístula e úlcera gástrica, dentre outros ( Quando se trata de pacientes que têm o desejo de ter filhos, elas são orientadas a aguardar dois anos após a realização da cirurgia bariátrica para engravidar. No entanto, faltam evidências quanto a essa orientação (ROBSON S, et al, 2015). No que diz respeito às complicações gestacionais relacionadas a mulheres que realizaram a cirurgia bariátrica, existem estudos demonstrando prematuridade, necessidade de parto cesáreo e recém-nascido PIG (STUART A e KÜLLEN K, 2017).…”

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

“…A few years ago, there was a lack of structured studies, but with growing numbers of bariatric procedures, more and more studies were started, such as the multicenter prospective cohort Aurora study [61,86,87].…”