Hakan BULUŞ, Yusuf Aytaç TOHMA, Emre GÜNAKAN

Early pregnancy after bariatric surgery: a single-institute preliminary experience

Background/aim: Pregnancy after bariatric surgery is an issue of growing importance with increasing number of women undergoingbariatric surgery. Therefore, in this study we present patients who conceived after sleeve gastrectomy and evaluate the obstetric outcomes.Materials and methods: This retrospective case-control study includes 23 women who conceived after laparoscopic sleeve gastrectomy.Patients were evaluated in two groups according to the number of months between surgery and conception (group 1: ≤12 months; group2: >12 months).Results: The mean body mass index of patients before surgery and at the time of conception was 46.6 kg/m2 and 29.7 kg/m2, respectively.Nine patients (39.1%) had a history of infertility. There was no statistical difference between groups 1 and 2 for haemoglobin, ferritin,and 25-OH Vit-D levels or maternofoetal complication rates and pregnancy outcomes. Enteral nutrition requirements and intravenousiron replacement needs were higher in group 1, although this difference was not statistically significant.Conclusion: Pregnancy in the first years after sleeve gastrectomy seems to have similar obstetric outcomes compared to pregnanciesoccurring later, but it remains a controversial issue. Although the results did not have statistical significance in our study, well-designedprospective series may determine the role of enteral nutrition and intravenous iron replacement in patient management.

PDF

___

1. Gundogan K, Bayram F, Gedik V, Kaya A, Karaman A et al. Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults. Archives of Medical Science 2013; 9 (2): 243-253.
2. Dolin C, Ude Welcome AO, Caughey AB. Management of pregnancy in women who have undergone bariatric surgery. Obstetrical & Gynecological Survey 2016; 71 (12): 734-740.
3. Shawe J, Ceulemans D, Akhter Z, Neff K, Hart K et al. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care. Obesity Reviews 2019; 20 (11): 1507-1522.
4. Carreau AM, Nadeau M, Marceau S, Marceau P, Weisnagel SJ. Pregnancy after bariatric surgery: Balancing risks and benefits. Canadian Journal of Diabetes 2017; 41 (4): 432-438.
5. Shekelle PG, Newberry S, Maglione M, Li Z, Yermilov I et al. Bariatric surgery in women of reproductive age: special concerns for pregnancy. Evidence Reports/Technology Assessments 2008 (169): 1-51.
6. Ovesen PG, Jensen DM, Damm P, Rasmussen S, Kesmodel US. Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. A nation-wide study. Journal of Maternal- Fetal and Neonatal Medicine 2015; 28 (14): 1720-1724.
7. Kjaer MM, Nilas L. Timing of pregnancy after gastric bypass—a national register-based cohort study. Obesity Surgery 2013; 23 (8): 1281-1285.
8. Johansson K, Cnattingius S, Naslund I, Roos N, Trolle Lagerros Y et al. Outcomes of pregnancy after bariatric surgery. New England Journal of Medicine 2015; 372 (9): 814-824.
9. Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obesity Surgery 2008; 18 (8): 1023-1027.
10. Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Human Reproduction Update 2009; 15 (2): 189-201.
11. Ciangura C, Coupaye M, Deruelle P, Gascoin G, Calabrese D et al. Clinical practice guidelines for childbearing female candidates for bariatric surgery, pregnancy, and post-partum management after bariatric surgery. Obesity Surgery 2019; 29 (11): 3722-3734.
12. Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA et al. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. American Journal of Obstetrics and Gynecology 2004; 190 (4): 1091-1097.
13. Galazis N, Docheva N, Simillis C, Nicolaides KH. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2014; 181: 45-53.
14. Yi XY, Li QF, Zhang J, Wang ZH. A meta-analysis of maternal and fetal outcomes of pregnancy after bariatric surgery. International Journal of Gynecology & Obstetrics 2015; 130 (1): 3-9.
15. Rottenstreich A, Elazary R, Goldenshluger A, Pikarsky AJ, Elchalal U et al. Maternal nutritional status and related pregnancy outcomes following bariatric surgery: A systematic review. Surgery for Obesity and Related Diseases 2019; 15 (2): 324-332.
16. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstetrics & Gynecology 2009; 113 (6): 1405-1413.
17. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 (Suppl 1): S1-27.
18. Malakauskiene L, Nadisauskiene RJ, Ramasauskaite D, Bartuseviciene E, Ramoniene G et al. Is it necessary to postpone pregnancy after bariatric surgery: a national cohort study. Journal of Obstetrics and Gynaecology 2019: 1-5.
19. Maslin K, James A, Brown A, Bogaerts A, Shawe J. What is known about the nutritional intake of women during pregnancy following bariatric surgery? A scoping review. Nutrients 2019; 11 (9): 2116.
20. Decker GA, Swain JM, Crowell MD, Scolapio JS. Gastrointestinal and nutritional complications after bariatric surgery. American Journal of Gastroenterology 2007; 102 (11): 2571-2580.
21. Pournaras DJ, Manning L, Bidgood K, Fender GR, Mahon D et al. Polycystic ovary syndrome is common in patients undergoing bariatric surgery in a British center. Fertility and Sterility 2010; 94 (2): e41.