Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution

• Published in: Surgery for obesity and related diseases Vol. 10; no. 6; pp. 1166 - 1173
• Main Authors: Mead, Nancy C., M.Sc, Sakkatos, Panagiotis, B.Sc, Sakellaropoulos, George C., Ph.D, Adonakis, George L., M.D, Alexandrides, Theodore K., M.D, Kalfarentzos, Fotis, M.D., F.A.C.S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2014
• Subjects: Adult; Analysis of Variance; Anemia; Bariatric surgery; Biliopancreatic Diversion - adverse effects; Biliopancreatic Diversion - methods; Birth Weight; Body Mass Index; Cohort Studies; Female; Folic acid; Gastrectomy - adverse effects; Gastrectomy - methods; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastroenterology and Hepatology; Gestational Age; Humans; Infant, Newborn; Laparoscopy - methods; Macrosomia; Malnutrition - etiology; Malnutrition - physiopathology; Maternal Age; Neonatal outcomes; Nutritional indices; Nutritional Status; Obesity, Morbid - diagnosis; Obesity, Morbid - surgery; Pregnancy; Pregnancy Outcome; Prenatal Care - methods; Protein malnutrition; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Surgery; Vitamin B 12 Deficiency - etiology; Vitamin B 12 Deficiency - physiopathology; Vitamin B12; Weight Loss; Pregnancy; Nutritional indices; Anemia; Neonatal outcomes; Bariatric surgery; Vitamin B 12; Birth weight; Protein malnutrition; Folic acid; Gestational age; Macrosomia; Vitamin B12; Vitamin B
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2014.02.011

Abstract Background Nutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes after bariatric surgery is an important issue that warrants further study. The objective of this study was to investigate pregnancy outcomes and nutritional indices after restrictive and malabsorptive procedures. Methods We investigated pregnancy outcomes of 113 women who gave birth to 150 children after biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 presurgery pregnancies in 36 women of the same group. Results Anemia was observed in 24.2% and 15.6% of pregnancies after BPD and RYGB, respectively. Vitamin B12 levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined as<2500 g. A comparison of neonatal data between babies born before surgery and siblings born after surgery (AS) showed that AS newborns had lower average birth weight with no significant differences in body length or head circumference and no cases of macrosomia. Conclusion Our study showed reasonably good pregnancy outcomes in this sample population after all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies after malabsorptive procedures especially regarding protein nutrition.