Effects of nutritional status on pregnancy after bariatric surgery

Abstract

Obesity is an important public health problem worldwide and increases the risk of many chronic diseases. Obesity can also cause health problems such as infertility and polycystic ovary syndrome in women of childbearing age. However, obese pregnant women are at greater risk of preeclampsia and gestational diabetes. Therefore, weight loss in women with obesity will both increase the probability of conception and reduce the risk of complications that may occur during pregnancy. Especially women prefer bariatric surgery for weight loss in recent years. While the risk of complications that may occur during pregnancy decreases with weight loss after bariatric surgery, nutritional deficiencies may occur due to insufficient nutrition and may affect the fetal development of the baby. For this reason, women should not become pregnant for at least 12-18 months after bariatric surgery, necessary supplements should be taken before pregnancy and regular follow-ups should be made. The purpose of this review is to examine how nutritional status after bariatric surgery affects the pregnancy process.

Keywords

• Bariatric surgery
• obesity
• fetal development
• pregnancy nutrition

Bariyatrik cerrahi sonrası beslenme durumunun gebelik üzerine etkileri

Abstract

Obezite dünya genelinde önemli bir halk sağlığı sorunudur ve birçok kronik hastalığın oluşum riskini artırmaktadır. Obezite doğurganlık çağındaki kadınlarda infertilite ve polikistik over sendromu gibi sağlık sorunlarının görülmesine de neden olabilmektedir. Bununla birlikte obez gebeler daha fazla preeklemsi ve gestasyonel diyabet riski altındadırlar. Bu yüzden obez kadınlarda ağırlık kaybı hem gebe kalma ihtimalini artıracaktır hem de gebelikte oluşabilecek komplikasyonların riskini azaltacaktır. Özellikle kadınlar son yıllarda bariyatrik cerrahiyi ağırlık kaybı için yaygın olarak tercih etmektedir. Bariyatrik cerrahi sonrası ağırlık kaybı ile gebelikte oluşabilecek komplikasyonların riski azalırken, yetersiz beslenme nedeniyle besin ögesi yetersizlikleri görülebilir ve fetal gelişimini etkileyebilir. Bu sebeple bariyatrik cerrahi sonrası kadınların en az 12-18 ay gebe kalmamaları, gebelik öncesinden itibaren gerekli takviyelerin alınması ve düzenli olarak takiplerinin yapılması gerekmektedir. Bu derlemenin amacı, bariyatrik cerrahi sonrası beslenme durumunun gebelik sürecini nasıl etkilendiğini incelemektir.

Keywords

• Bariatrik cerrahi
• obezite
• fetal gelişim
• gebelikte beslenme

References

1. WHO. Obesity and overweight [Internet]. 2021 [cited 2022 Dec 11]. Web site. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Published Jun 9, 2021. Accessed Dec 11, 2022.
2. Christ JP, Falcone T. Bariatric Surgery Improves Hyperandrogenism, Menstrual Irregularities, and Metabolic Dysfunction Among Women with Polycystic Ovary Syndrome (PCOS). Obes Surg. 2018;28(8):2171–7.
3. D’Souza R, Horyn I, Pavalagantharajah S, Zaffar N, Jacob CE. Maternal body mass index and pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol MFM. 2019;1(4): 100041.
4. Haseeb YA. A Review of Obstetrical Outcomes and Complications in Pregnant Women after Bariatric Surgery. Sultan Qaboos Univ Med J. 2019;19(4):e284.
5. Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen R V., et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surgery for obesity and related diseases . 2022;18(12):1345–56.
6. Huang B, Yo JH, Gandhi S, Maxwell C. Micronutrient screening, monitoring, and supplementation in pregnancy after bariatric surgery. Obstet Med. 2022;15(3):151–9.
7. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye Beslenme Ve Sağlık Araştırması (TBSA). Ankara: Sağlık Bakanlığı Yayın No : 1132; 2019.
8. Alamri SH, Abdeen GN. Maternal Nutritional Status and Pregnancy Outcomes Post-bariatric Surgery. Obes Surg. 2022;32(4):1325–40.

9. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ . 2017;356.
10. Wiechert M, Holzapfel C. Nutrition Concepts for the Treatment of Obesity in Adults. Nutrients. 2021;14(1):169.
11. Heslehurst N, Vieira R, Hayes L, Crowe L, Jones D, Robalino S, et al. Maternal body mass index and post-term birth: a systematic review and meta-analysis. Obesity Reviews. 2017;18(3):293–308.
12. Sun Y, Shen Z, Zhan Y, Wang Y, Ma S, Zhang S, et al. Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications. BMC Pregnancy Childbirth. 2020;20(1):690.
13. Fallatah AM, Babatin HM, Nassibi KM, Banweer MK, Fayoumi MN, Oraif AM. Maternal and Neonatal Outcomes among Obese Pregnant Women in King Abdulaziz University Hospital: A Retrospective Single-Center Medical Record Review. Med Arch. 2019;73(6):425–32.
14. Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling. Obstetrics and gynecology. 2015;125(1):133–43.
15. Haseeb YA. Obstetric Outcome in Obese Saudi Pregnant Women: A Cohort Prospective Study at a Teaching Hospital. Saudi J Med Med Sci. 2017;5(2):142.
16. ASMBS. Metabolic and Bariatric Surgery Fact Sheet. Web site. https://asmbs.org/resources/metabolic-and-bariatric-surgery. Published Jul, 2021. Accessed May 15, 2023.
17. Buchwald H, Buchwald JN, Pories WJ, Hoyt DB. Executive Summary: Collected Papers of the American College of Surgeons Metabolic Surgery Symposium. Obes Surg. 2020;30(5):1961–70.
18. Hubbard V, Hall W. Gastrointestinal Surgery for Severe Obesity. Obes Surg. 1991;1(3):257–65.
19. Carreau AM, Nadeau M, Marceau S, Marceau P, Weisnagel SJ. Pregnancy after Bariatric Surgery: Balancing Risks and Benefits. Can J Diabetes. 2017;41(4):432–8.
20. Riley L, Wertz M, McDowell I. Obesity in Pregnancy: Risks and Management. Am Fam Physician. 2018;97(9):559–61.
21. Menke MN, King WC, White GE, Gosman GG, Courcoulas AP, Dakin GF, et al. Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study. Surg Obes Relat Dis . 2019;15(5):777–85.
22. Ducarme G, Chesnoy V, Lemarié P, Koumaré S, Krawczykowski D. Pregnancy outcomes after laparoscopic sleeve gastrectomy among obese patients. Int J Gynaecol Obstet. 2015;130(2):127–31.
23. González I, Rubio MA, Cordido F, Bretón I, Morales MJ, Vilarrasa N, et al. Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obes Surg. 2015;25(3):436–42.
24. Rottenstreich A, Levin G, Kleinstern G, Rottenstreich M, Elchalal U, Elazary R. The effect of surgery-to-conception interval on pregnancy outcomes after sleeve gastrectomy. Surgery for obesity and related diseases. 2018;14(12):1795–803.
25. Ceulemans D, De Mulder P, Lebbe B, Coppens M, De Becker B, Dillemans B, et al. Gestational weight gain and postpartum weight retention after bariatric surgery: data from a prospective cohort study. Surg Obes Relat Dis. 2021;17(4):659–66.
26. Shawe J, Ceulemans D, Akhter Z, Neff K, Hart K, Heslehurst N, et al. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care. Obesity reviews. 2019;20(11):1507–22.
27. Akhter Z, Rankin J, Ceulemans D, Ngongalah L, Ackroyd R, Devlieger R, et al. Pregnancy after bariatric surgery and adverse perinatal outcomes: A systematic review and meta-analysis. PLoS Med. 2019;16(8): e1002866.
28. Pg Baharuddin DM, Payus AO, Abdel Malek Fahmy EH, Sawatan W, Than WW, Abdelhafez MM, et al. Bariatric surgery and its impact on fertility, pregnancy and its outcome: A narrative review. Annals of Medicine and Surgery. 2021;72: 103038.
29. Rasmussen KM, Yaktine AL, Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines (Eds.). Weight Gain During Pregnancy: Reexamining the Guidelines. National Academies Press (US). 2009.
30. Bavaresco M, Paganini S, Lima TP, Salgado W, Ceneviva R, Dos Santos JE, et al. Nutritional course of patients submitted to bariatric surgery. Obes Surg. 2010;20(6):716–21.
31. Aron-Wisnewsky J, Verger EO, Bounaix C, Dao MC, Oppert JM, Bouillot JL, et al. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding. PLoS One. 2016;11(2):e0149588.
32. Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, et al. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts. 2018;10(6):597–632.
33. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye Beslenme Rehberi (TÜBER) 2022. Ankara: Sağlık Bakanlığı Yayın No:1031; 2022.
34. Institute of Medicine (IOM). Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, D.C.: National Academies Press; 2006.
35. Rottenstreich A, Elazary R, Goldenshluger A, Pikarsky AJ, Elchalal U, Ben-Porat T. Maternal nutritional status and related pregnancy outcomes following bariatric surgery: A systematic review. Surg Obes Relat Dis. 2019;15(2):324–32.
36. Watanabe A, Seki Y, Haruta H, Kikkawa E, Kasama K. Maternal impacts and perinatal outcomes after three types of bariatric surgery at a single institution. Arch Gynecol Obstet. 2019;300(1):145–52.
37. Mead NC, Sakkatos P, Sakellaropoulos GC, Adonakis GL, Alexandrides TK, Kalfarentzos F. Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution. Surg Obes Relat Dis. 2014;10(6):1166–73.
38. Gascoin G, Gerard M, Sallé A, Becouarn G, Rouleau S, Sentilhes L, et al. Risk of low birth weight and micronutrient deficiencies in neonates from mothers after gastric bypass: a case control study. Surg Obes Relat Dis. 2017;13(8):1384–91.
39. Cruz S, Matos A, Da Cruz SP, Pereira S, Saboya C, Ramalho A. Relationship between the Nutritional Status of Vitamin A per Trimester of Pregnancy with Maternal Anthropometry and Anemia after Roux-en-Y Gastric Bypass. Nutrients. 2017;9(9):1–10.
40. Devlieger R, Guelinckx I, Jans G, Voets W, Vanholsbeke C, Vansant G. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study. PLoS One. 2014;9(12): e114192.
41. Jans G, Matthys C, Bogaerts A, Lannoo M, Verhaeghe J, Van der Schueren B, et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Adv Nutr. 2015;6(4):420–9.
42. Slater C, Morris L, Ellison J, Syed AA. Nutrition in Pregnancy Following Bariatric Surgery. Nutrients. 2017;9(12):1338.