Pregnancy Nutritional Indices and Birth Weight After Roux-en-Y Gastric Bypass
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Maternal metabolic profile and nutritional course of pregnancy after bariatric interventions is incompletely known. Their impact on birth weight has also not been hitherto addressed. Aiming to document such variables, a retrospective study was undertaken.
Women previously submitted to silastic ring Roux-en-Y gastric bypass, who conceived after 0–5 years (n = 14), were investigated. Intake of selected macro- and micronutrients, representative laboratory measurements, and correlation of these findings with birth weight and time to conception was documented.
Mean calorie intake was restricted to about 1,800 kcal/day. Protein (71 ± 17 g/day) and supplementary iron (60 mg/day) were barely adequate, and calcium and vitamin B12 did not meet current recommendations, only folic acid being optimal. Biochemical monitoring reflected these inconsistencies, with occasional low values for serum albumin (4.1 ± 0.4 g/dL), hemoglobin (11.4 ± 1.5 g/dL), iron (78 ± 50 μg/dL) and vitamin B12 (193 ± 102 pg/mL) but not folate. Lipids, glucose, and uric acid were much better than before the anti-obesity intervention. Reduced plasma lipids, glucose, and uric acid were associated with larger birth weight, albeit within the normal range.
(1) Anemia as well as additional nutritional deficits during pregnancy were not totally eliminated, despite dietary guidance and micronutrient supplementation; (2) alleviation of metabolic comorbidities was demonstrated, and improved normalization predicted higher birth weight; (3) energy and folate intake was sufficient, but other nutrients probably did not reach ideal levels; (4) recent dietary guidelines for this population represent a step forward, but additional studies are needed.
- Taylor JL, O’Leary JP. Pregnancy following jejunoileal bypass. Effects on fetal outcome. Obstet Gynecol. 1976;48:425–7.
- Sheiner E, Levy A, Siverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 2004;190:1335–40. CrossRef
- Karmon A, Sheiner E. Pregnancy after bariatric surgery: a comprehensive review. Arch Gynecol Obstet. 2008;277:381–8. CrossRef
- Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg 2008;18:1023–7. CrossRef
- Scholl TO. Maternal nutrition before and during pregnancy. Nestle Nutr Workshop Ser Pediatr Program 2008;61:79–89. CrossRef
- Supplementation with multiple micronutrients intervention trial (SUMMIT) Study GroupShankar AH, Jahari AB, et al. Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet 2008;371(9608):215–27. CrossRef
- Gupta P, Ray M, Dua T, et al. Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. Arch Pediatr Adolesc Med. 2007;161:58–64. CrossRef
- Goldenberg RL, Culhane JF. Low birth weight in the United States. Am J Clin Nutr. 2007;85:584S–590S.
- Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2006;(4):CD004905;
- Ju H, Rumbold AR, Wilson KJ, et al. Borderline gestational diabetes mellitus and pregnancy outcomes. BMC Pregnancy Childbirth 2008 30;8:31. CrossRef
- Yajnik CS, Deshmukh US. Maternal nutrition, intrauterine programming and consequential risks in the offspring. Rev Endocr Metab Disord 2008;9:203–11. CrossRef
- Grissa O, Ategbo JM, Yessoufou A, et al. Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia. Transl Res 2007;150:164–71. CrossRef
- Faintuch J, Ishida RK, Ribeiro AS, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg 2007;142:962–8. CrossRef
- Subcommittee on Nutritional Status and Weigh Gain During Pregnancy. Nutrition during pregnancy. Washington, DC: Institute of Medicine, National Academy of Sciences; 1990.
- Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. Endocr Pract 2008;14(Suppl 1):1–83.
- Molloy AM, Kirke PN, Brody LC, et al. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull 2008;29(2 Suppl):S101–11.
- Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008;18:288–93. CrossRef
- Kaiser L, Allen LH. American Dietetic Association. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2008;108:553–61. CrossRef
- Giroux I, Inglis SD, Lander S, et al. Dietary intake, weight gain, and birth outcomes of physically active pregnant women: a pilot study. Appl Physiol Nutr Metab 2006;31:483–9. CrossRef
- Pregnancy Nutritional Indices and Birth Weight After Roux-en-Y Gastric Bypass
Volume 19, Issue 5 , pp 583-589
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Bariatric surgery
- Roux-en-Y gastric bypass
- Birth weight
- Serum lipids
- Vitamin B12
- Folic acid
- Industry Sectors
- Author Affiliations
- 1. Nutrology Group, Hospital das Clinicas, Avenida Eneias C Aguiar 255-9th Floor, Rm 9077, Sao Paulo, Sao Paulo, 05403-900, Brazil
- 2. Division of Nutrition and Dietetics and Nutrology Group, Hospital das Clinicas, Sao Paulo, Brazil
- 3. Division of Nutrition and Dietetics, Hospital das Clinicas, Sao Paulo, Brazil
- 4. Department of Gynecology and Obstetrics, Hospital das Clinicas, Sao Paulo, Brazil
- 5. Division of Gastrointestinal Surgery, Hospital das Clinicas, Sao Paulo, Brazil