Gastric bypass: a risk factor for neural tube defects?

Moliterno, Jennifer; DiLuna, Michael L.; Sood, Shreya; Roberts, Kurt E.; Duncan, Charles C.

doi:10.3171/ped/2008/1/5/406

Cited by 28 publications

(14 citation statements)

References 19 publications

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“…75 However, there have been isolated case reports of neural tube defects attributed to folate deficiency following pregnancy in women who have undergone RYGB but not complied with their recommended daily multivitamin intake. 76 This finding confirms how important it is that patients comply with daily supplementation and supports the idea that daily folic acid supplementation should be considered in women of child-bearing age (Box 4).…”

Section: Thiamine Deficiencysupporting

confidence: 80%

Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery

Bal

Koch

Finelli

et al. 2010

Nat Rev Gastroenterol Hepatol

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The National Longitudinal Study of Adolescent Health and the National Health and Nutrition Examination Survey reported that over 40% of the US population is overweight. The average weight loss attained by medical management programs is neither sufficient nor durable enough to treat medically complicated obesity. An estimated 220,000 bariatric procedures are performed yearly in the USA and Canada. The divided Roux-en-Y gastric bypass (RYGB) is performed most commonly in these countries and is considered the gold standard bariatric surgical procedure. The complexity of RYGB means that serious and potentially preventable perioperative complications can occur. RYGB alters the normal anatomy and physiology of the upper gut, which has predictable adverse effects and potential complications. Patients seek advice and care for symptoms that develop or persist after RYGB; although some symptoms are expected and predictable, others are complications that may or may not require active medical or surgical intervention. Physicians should be able to predict and manage most postoperative medical and nutritional disorders related to RYGB and should be prepared to assess patients for potential referral for surgical intervention or revision.

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Section: Thiamine Deficiencysupporting

confidence: 80%

Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery

Bal

Koch

Finelli

et al. 2010

Nat Rev Gastroenterol Hepatol

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“…For this reason, it is recommended to delay pregnancy until 12-18 mo after surgery (42). Surprisingly, only a limited number of the case studies presented data on micronutrient deficiencies and adverse events in women who became pregnant within 18 mo after surgery (12,22,24,34,35). In addition, the mean period between surgery and conception in the cohort studies varied between 18 and 36 mo, with no or very limited information on the critical period of the first 18 mo after surgery.…”

Section: Discussionmentioning

confidence: 86%

“…Pelizzo et al (11,12) described 4 NTDs, of which 3 presented in a folate-deficient woman with RYGB and 1 in a folate-deficient woman with BPD. Another case of depleted maternal folate and vitamin B-12 concentrations accompanied with the presence of NTDs was described by Moliterno et al (34). Low iron concentrations were found in ;10 cases independently of the type of procedure, and no significant maternal and neonatal adverse outcomes were reported (11,12,24,25,33,35).…”

Section: Primary and Secondary Outcome Measuresmentioning

confidence: 92%

“…Vitamin B-12 deficiency in pregnancy after bariatric surgery did not always result in complications in the mother and child (29). Maternal vitamin B-12 deficiency can result in clinical neurological disease and developmental delay in the neonate (11,12,24,(30)(31)(32)(33)(34). Maternal deficiency in vitamin B-12 may affect the amount of vitamin B-12 in breast milk, as reported in 2 exclusively breastfed children of mothers with a history of RYGB (30,31).…”

Section: Primary and Secondary Outcome Measuresmentioning

confidence: 92%

See 1 more Smart Citation

Maternal Micronutrient Deficiencies and Related Adverse Neonatal Outcomes after Bariatric Surgery: A Systematic Review

Jans¹,

Matthys

Bogaerts

et al. 2015

Advances in Nutrition

117

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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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“…Peu de conséquences maternofoetales des complications nutritionnelles sont décrites dans la litté-rature concernant les grossesses après chirurgie bariatrique. Mais, comme les séries publiées ne reposent que sur de petits effectifs, les carences en folates, par exemple, et leurs effets sur les malformations du tube neural n'ont pas été ou peu évalués [69,70]. Un cas clinique récent rapporte une hémorragie intracérébrale chez un foetus en rapport avec une carence en vitamine K liée aux vomissements exacerbés chez une patiente porteuse d'un AG [71].…”

Section: Grossesses Après Roux-en-y Gastric Bypassunclassified