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

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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.

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References

  1. Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg 2003;13:329–30.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  3. Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289:187–93.

    Article  PubMed  Google Scholar 

  4. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol 2007;109:419–33.

    PubMed  Google Scholar 

  5. Eisenberg D, Duffy AJ, Bell RL. Update on obesity surgery. World J Gastroenterol 2006;12:3196–203.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  7. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.

    Article  PubMed  CAS  Google Scholar 

  8. Adams TD, Gress RE, Smith SC, et al. Long term mortality after gastric bypass surgery. N Engl J Med 2007;357:753–61.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  10. American College of Obstetricians and Gynecologists. ACOG Committee Opinion 315: obesity in pregnancy. Obstet Gynecol 2005;106:671–5.

    Google Scholar 

  11. Buchwald H, Williams SE. Bariatric surgery worldwide. Obes Surg 2004;14:1263–72.

    Article  Google Scholar 

  12. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci 2006;331:219–25.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  14. Wax JR, Pinette MG, Cartin A, et al. Female reproductive issues following bariatric surgery. Obstet Gynecol Surv 2007;62:595–604.

    Article  PubMed  Google Scholar 

  15. Nelson FM, Fleming R. Obesity and reproduction: impact and interventions. Curr Opin Obstet Gynecol 2007;19:384–9.

    Article  PubMed  Google Scholar 

  16. Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG 2006;113:1148–59.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  18. Teitelman M, Grotegut CA, Williams NN, et al. The impact of bariatric surgery on menstrual patterns. Obes Surg 2006;16:1457–63.

    Article  PubMed  Google Scholar 

  19. Poitou Bernert C, Ciangura M, Coupaye S, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention, treatment. Diabetes Metab 2007;33:13–24.

    Article  PubMed  CAS  Google Scholar 

  20. Elliot K. Nutritional considerations after bariatric surgery. Crit Care Nurs Q 2003;26:133–8.

    PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  22. Brolin RE, Gorman JH, Gorman RC. Prophylactic iron supplementation after Roux-en-Y gastric bypass. Arch Surg 1998;133:740–4.

    Article  PubMed  CAS  Google Scholar 

  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. Gurewitsch ED, Smith-Levitin M, Mack J. Pregnancy following gastric bypass for morbid obesity. Obstet Gynecol 1996;88:658–61.

    Article  PubMed  CAS  Google Scholar 

  25. Haddow JE, Hill LE, Kloza EM, et al. Neural tube defects after gastric bypass. Lancet 1986;1:1330.

    Article  PubMed  CAS  Google Scholar 

  26. Granstrom L, Granstrom L, Backman L. Fetal growth retardation after gastric banding. Acta Obstet Gynecol Scand 1990;69:533–6.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  30. Dao T, Kuhn J, Ehmer D, et al. Pregnancy outcomes after gastric-bypass surgery. Am J Surg 2006;192:762–66.

    Article  PubMed  Google Scholar 

  31. Wittgrove AC, Jester L, Wittgrove P, et al. Pregnancy following gastric bypass for morbid obesity. Obes Surg 1998;8:461–4.

    Article  PubMed  CAS  Google Scholar 

  32. Dixon JB, Dixon ME, O’Brien PE. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005;106:965–72.

    PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  34. Martin LF, Finigan KM, Nolan TE. Pregnancy after adjustable gastric banding. Obstet Gynecol 2000;95:927–30.

    Article  PubMed  CAS  Google Scholar 

  35. Printen KJ, Scott D. Pregnancy following gastric bypass for the treatment of morbid obesity. Am Surg 1982;48:363–65.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Section of Gastrointestinal Surgery, Department of Surgery, Yale University School of Medicine, 40 Temple St. Suite 7B, New Haven, CT, 06510, USA

    Jessica H. Beard, Robert L. Bell & Andrew J. Duffy

Authors
  1. Jessica H. Beard
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  2. Robert L. Bell
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  3. Andrew J. Duffy
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Correspondence to Andrew J. Duffy.

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Beard, J.H., Bell, R.L. & Duffy, A.J. Reproductive Considerations and Pregnancy after Bariatric Surgery: Current Evidence and Recommendations. OBES SURG 18, 1023–1027 (2008). https://doi.org/10.1007/s11695-007-9389-3

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  • DOI: https://doi.org/10.1007/s11695-007-9389-3

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