Management of Pregnant Women after Bariatric Surgery

Abstract

The prevalence of obesity is growing worldwide, and strategies to overcome this epidemic need to be developed urgently. Bariatric surgery is a very effective treatment option to reduce excess weight and often performed in women of reproductive age. Weight loss influences fertility positively and can resolve hormonal imbalance. So far, guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12–24 months after surgery. As limited data of these suggestions exist, further evidence is urgently needed as well for weight gain in pregnancy. Oral glucose tolerance tests for the diagnosis of gestational diabetes mellitus (GDM) should not be performed after bariatric procedures due to potential hypoglycaemic adverse events and high variability of glucose levels after glucose load. This challenges the utility of the usual diagnostic criteria for GDM in accurate prediction of complications. Furthermore, recommendations on essential nutrient supplementation in pregnancy and lactation in women after bariatric surgery are scarce. In addition, nutritional deficiencies or daily intake recommendations in pregnant women after bariatric surgery are not well investigated. This review summarizes current evidence, proposes clinical recommendations in pregnant women after bariatric surgery, and highlights areas of lack of evidence and the resulting urgent need for more clinical investigations.

Outcome of Pregnancy after Bariatric Surgery at Latifa Hospital, DHA, Dubai, UAE

“…Women in reproductive age after bariatric surgery need to be informed that the probability to get pregnant without enough contraception is increased. So far, guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12 -24 months after surgery [3]. Here we observed short interval between the surgery and pregnancy is documented finding although all cases received good education and information of family planning for their coming pregnancy inspite pregnancy came earlier than expected.…”

“…As the prevalence of obesity is growing worldwide, effective weight loss approaches are necessary to overcome the negative long-term effects of obesity. Among lifestyle modification, medical treatment and surgical interventions, bariatric surgery is a commonly used method in severely obese patients, which was demonstrated to result in good weight loss outcome [3].…”

“…There is little evidence in various important fields and aspects around pregnant women who underwent bariatric surgery about ideal time of pregnancy after surgery, diagnostic criteria and best ways and methods to identify GDM, diabetes in pregnancy, and treatment goals after diagnosis. As well as for pregnant women after metabolic surgery, further information on optimal weight gain in pregnancy, potential lack of several nutrients and nutritional intake recommendations in pregnancy and lactation, effects of nutritional deficiencies on fetal development, and long-term consequences in offspring is urgently needed and is of high scientific and clinical interest facing growing surgery numbers in women of reproductive age [3].…”

Gestationsdiabetes (GDM) (Update 2019)

“…Der OGTT ist im Mutter-Kind-Pass verankert und verpflichtend für den Erhalt des vollen Kinderbetreuungsgelds. Ebenfalls ausgenommen von der Durchführung eines OGTT sollen Frauen nach metabolischer Chirurgie werden, da das Risiko einer postprandialen Hypoglykämie (Dumping-Phänomen) nach der Ingestion der Glukoselösung besonders hoch ist [8]. Nach bariatrischer Operation werden daher regelmäßige Blutzuckerselbstkontrollen zur Diagnose eines GDM herangezogen.…”

“…Nach bariatrischer Operation werden daher regelmäßige Blutzuckerselbstkontrollen zur Diagnose eines GDM herangezogen. Ebenso ist die Verwendung eines Continuous Glucose Monitoring Systems (CGMS) in diesem Fall denkbar [8] (Evidenzklasse C).…”