Pregnancy Following Bariatric Surgery—Medical Complications and Management

Abstract

Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12–24 months to reduce the potential risk of intrauterine growth retardation. Dumping syndromes are common after bariatric surgery and can present diagnostic and therapeutic challenges in pregnancy. Early dumping occurs due to osmotic fluid shifts resulting from rapid gastrointestinal food transit, whilst late dumping is characterized by a hyperinsulinemic response to rapid absorption of simple carbohydrates. Dietary measures are the mainstay of management of dumping syndromes but pharmacotherapy may sometimes become necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize the nutritional status of women prior to and during pregnancy. Dietary management should include adequate protein and calorie intake and supplementation of vitamins and micronutrients. A high clinical index of suspicion is required for early diagnosis of surgical complications of prior weight loss procedures during pregnancy, including small bowel obstruction, internal hernias, gastric band erosion or migration and cholelithiasis.

Immediate return of fertility function following a bariatric surgery: A case report

“…We report a case with an immediate return of fertility function following bariatric surgery with favorable pregnancy outcomes. Obesity in women is associated with infertility and PCOS characterized by oligoovulation and hyperandrogenism mediated by insulin resistance and hyperinsulinemia . Previous studies demonstrated that 5–10% weight loss by lifestyle intervention can increase frequency of ovulation and can improve fertility outcomes .…”

“…Obesity in women of childbearing age is linked to lower fertility rates due to chronic oligoovulation and anovulation . Weight loss treatment can improve menstrual regularity and can also result in an amelioration of polycystic ovarian syndrome (PCOS)‐linked health complications . Bariatric surgery is by far the most effective weight loss treatment and an improvement in fertility rates after bariatric surgery were observed in several studies .…”

Pregnancy after bariatric surgery: screening for gestational diabetes

“…Guidance is also required on nutritional supplements, since micronutrient deficiencies could theoretically contribute to adverse pregnancy outcomes. 2 …”

Weight Loss Surgery in Adolescents

“…A few small studies cite increases in pregnancy rates after WLS, which may be due to improvement of anovulatory cycles in women of childbearing age 76 . For adolescents, 1 study reported a post‐RYGB pregnancy rate that was double the national norms; however, this impression should be tempered by the small numbers reported 77 .…”