The Impact of Preconception Gastric Bypass Surgery on Maternal Micronutrient Status before and during Pregnancy: A Retrospective Cohort Study in the Netherlands between 2009 and 2019

Abstract

Post-bariatric weight loss can cause iatrogenic malnutrition and micronutrient depletion. In this study, we evaluated the impact of gastric bypass surgery (GB) and multivitamin supplement use on maternal micronutrient status before and across pregnancy. A retrospective medical chart review of 197 singleton pregnancies after GB with a due date between 2009 and 2019 was performed at a bariatric expertise center in the Netherlands. Hemoglobin, calcium, iron status, folate, vitamin D, vitamin B12 and ferritin levels were determined before and after GB during standard follow-up and at all gestational trimesters and analyzed using linear mixed models. Patients were prescribed standard multivitamin supplements or multivitamins specifically developed for post-bariatric patients (FitForMe WLS Forte (FFM)). Overall, hemoglobin and calcium levels decreased after surgery and during pregnancy, whereas folate, vitamin D, and vitamin B12 levels increased, and iron levels remained stable. FFM use was associated with higher hemoglobin, folate, vitamin D, and ferritin levels. In conclusion, through adequate supplementation and follow-up, GB does not have to result in impaired micronutrient status. Supplements developed specifically for post-bariatric patients generally result in higher micronutrient values than regular multivitamins before and during pregnancy. These data emphasize the urgent need for nutritional counseling including dietary and multivitamin supplement advise for post-bariatric women contemplating and during pregnancy.

Pre-Operative Assessment of Micronutrients, Amino Acids, Phospholipids and Oxidative Stress in Bariatric Surgery Candidates

“…Data on severe vitamin D deficiency among obese patients depend on the selected cut-off values and range from 10.9-25.4% [29,32,33] (<25 nM) to 19-26.1% (<37.5 nM) [30,31]. It has been shown that by adequate supplementa-tion of micronutrients, the risk of deficiency, caused by malabsorption after surgery, can be prevented [40]. However, the adherence to recommended supplementation is low (approximately 30% six months after surgery) [41].…”

Nutritional Implications of Bariatric Surgery on Pregnancy Management—A Narrative Review of the Literature

“…Some studies indicate that continuous, adequate supplementation of standard multivitamin supplements of multivitamins specially developed for post-bariatric patients before and throughout pregnancy reduces the rate of observed deficiencies. In 197 pregnancy cases after RYGB, observed at a bariatric expertise center in the Netherlands, iron serum levels remained stable, folate, vitamin D, and vitamin B12 levels increased, and only hemoglobin and calcium levels were reported to have been decreased [17]. Eissa et al analyzed a group of 245 pregnant women after SG and found an incidence of anemia of 78.8% [18].…”

Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review

“…These data were confirmed in another retrospective study evaluating 42 pregnant women with a history of RYGB, also conducted in Brazil, which observed an inadequacy of vitamin D levels of up to 90 [ 103 ]. Bariatric multivitamins can prevent vitamin D deficiency during pregnancy in women with previous RYGB [ 104 ] As bariatric surgery increases the risk of vitamin D deficiency, pregnancy in women with BS may pose a risk to bone health if not adequately supplemented.…”