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Obesity Surgery

, Volume 18, Issue 8, pp 1023–1027 | Cite as

Reproductive Considerations and Pregnancy after Bariatric Surgery: Current Evidence and Recommendations

  • Jessica H. Beard
  • Robert L. Bell
  • Andrew J. Duffy
Review Article

Abstract

Obesity has reached epidemic proportions in the USA. Bariatric surgery is an important and increasingly utilized treatment option for morbid obesity refractory to medical therapy. Approximately half of all bariatric surgery patients are reproductive-aged women and, thus, represent a unique patient population with specific concerns. This manuscript focuses on issues of increased postoperative fertility, nutritional monitoring and supplementation, safety of pregnancy after bariatric surgery, and effect of pregnancy on postoperative weight loss. Current recommendations regarding management of patients both before and during pregnancy are provided. In addition, we highlight areas where more research on this issue is needed and advocate for a multidisciplinary approach to patient care.

Keywords

Morbid obesity Bariatric surgery Weight loss Fertility Pregnancy Prenatal nutrition physiology 

References

  1. 1.
    Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg 2003;13:329–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–55.PubMedCrossRefGoogle Scholar
  3. 3.
    Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289:187–93.PubMedCrossRefGoogle Scholar
  4. 4.
    Catalano PM. Management of obesity in pregnancy. Obstet Gynecol 2007;109:419–33.PubMedGoogle Scholar
  5. 5.
    Eisenberg D, Duffy AJ, Bell RL. Update on obesity surgery. World J Gastroenterol 2006;12:3196–203.PubMedGoogle Scholar
  6. 6.
    Hubbard VS, Hall WH. Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1991;1:257–65.PubMedCrossRefGoogle Scholar
  7. 7.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  8. 8.
    Adams TD, Gress RE, Smith SC, et al. Long term mortality after gastric bypass surgery. N Engl J Med 2007;357:753–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Sjöström L, Narbro K, Sjöström D, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741–52.PubMedCrossRefGoogle Scholar
  10. 10.
    American College of Obstetricians and Gynecologists. ACOG Committee Opinion 315: obesity in pregnancy. Obstet Gynecol 2005;106:671–5.Google Scholar
  11. 11.
    Buchwald H, Williams SE. Bariatric surgery worldwide. Obes Surg 2004;14:1263–72.CrossRefGoogle Scholar
  12. 12.
    Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci 2006;331:219–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Belle SH, Berk PD, Courcoulas, et al. Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery. Surg Obes Relat Dis 2007;3:116–26.PubMedCrossRefGoogle Scholar
  14. 14.
    Wax JR, Pinette MG, Cartin A, et al. Female reproductive issues following bariatric surgery. Obstet Gynecol Surv 2007;62:595–604.PubMedCrossRefGoogle Scholar
  15. 15.
    Nelson FM, Fleming R. Obesity and reproduction: impact and interventions. Curr Opin Obstet Gynecol 2007;19:384–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG 2006;113:1148–59.PubMedCrossRefGoogle Scholar
  17. 17.
    Eid GM, Cottam DR, Velcu, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis 2005;1(2):77–80.PubMedCrossRefGoogle Scholar
  18. 18.
    Teitelman M, Grotegut CA, Williams NN, et al. The impact of bariatric surgery on menstrual patterns. Obes Surg 2006;16:1457–63.PubMedCrossRefGoogle Scholar
  19. 19.
    Poitou Bernert C, Ciangura M, Coupaye S, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention, treatment. Diabetes Metab 2007;33:13–24.PubMedCrossRefGoogle Scholar
  20. 20.
    Elliot K. Nutritional considerations after bariatric surgery. Crit Care Nurs Q 2003;26:133–8.PubMedGoogle Scholar
  21. 21.
    Brolin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass? J Gastrointest Surg 1998;2:436–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Brolin RE, Gorman JH, Gorman RC. Prophylactic iron supplementation after Roux-en-Y gastric bypass. Arch Surg 1998;133:740–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Institute of Medicine (U.S.) Subcommittee on Nutritional Status and Weight Gain During Pregnancy. Nutrition during pregnancy. Washington DC: National Academy of Sciences; 1990.Google Scholar
  24. 24.
    Gurewitsch ED, Smith-Levitin M, Mack J. Pregnancy following gastric bypass for morbid obesity. Obstet Gynecol 1996;88:658–61.PubMedCrossRefGoogle Scholar
  25. 25.
    Haddow JE, Hill LE, Kloza EM, et al. Neural tube defects after gastric bypass. Lancet 1986;1:1330.PubMedCrossRefGoogle Scholar
  26. 26.
    Granstrom L, Granstrom L, Backman L. Fetal growth retardation after gastric banding. Acta Obstet Gynecol Scand 1990;69:533–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Ramirez MM, Turrentine MA. Gastrointestinal hemorrhage during pregnancy in a patient with history of vertical-banded gastroplasty. Am J Obstet Gynecol 2001;173:1630–1.CrossRefGoogle Scholar
  28. 28.
    Moore KA, Ouyang DW, Whang EE. Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med 2004;351:721–22.PubMedCrossRefGoogle Scholar
  29. 29.
    Sheiner E, Levy A, Silverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 2004;190:1335–40.PubMedCrossRefGoogle Scholar
  30. 30.
    Dao T, Kuhn J, Ehmer D, et al. Pregnancy outcomes after gastric-bypass surgery. Am J Surg 2006;192:762–66.PubMedCrossRefGoogle Scholar
  31. 31.
    Wittgrove AC, Jester L, Wittgrove P, et al. Pregnancy following gastric bypass for morbid obesity. Obes Surg 1998;8:461–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Dixon JB, Dixon ME, O’Brien PE. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005;106:965–72.PubMedGoogle Scholar
  33. 33.
    Skull AJ, Slater GH, Duncombe JE, et al. Laparoscopic adjustable banding in pregnancy: safety, patient tolerance, and effect on obesity-related pregnancy outcomes. Obes Surg 2004;14:230–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Martin LF, Finigan KM, Nolan TE. Pregnancy after adjustable gastric banding. Obstet Gynecol 2000;95:927–30.PubMedCrossRefGoogle Scholar
  35. 35.
    Printen KJ, Scott D. Pregnancy following gastric bypass for the treatment of morbid obesity. Am Surg 1982;48:363–65.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Jessica H. Beard
    • 1
  • Robert L. Bell
    • 1
  • Andrew J. Duffy
    • 1
  1. 1.Section of Gastrointestinal Surgery, Department of SurgeryYale University School of MedicineNew HavenUSA

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