Women who undergo bariatric surgery should be well informed to improve pregnancy-related outcomes.

Obesity increases the risk of infertility for men and women and decreases the effectiveness of fertility therapies, according to Dr. Sarah Cheah from the St George Hospital in Sydney.

Almost 60 percent of female patients who have bariatric surgery are within the age range of 20–44 years, and these women need appropriate advice and management around contraception, peri-conception nutrition and supplementation, and weight management during and after pregnancy.

Recommendations for Pregnancy after bariatric surgery:

• Pregnancy should be delayed by at least 12–18 months due to adverse pregnancy outcomes associated with rapid weight loss. Based on ACOG guidelines, If pregnancy occurs before this recommended time frame, closer surveillance of maternal weight and nutritional status may be beneficial, and serial ultrasound monitoring of fetal growth should be considered.
• Contraception should be prescribed after the surgery, although the effectiveness of the oral contraceptive pill may be reduced due to malabsorption, and contraceptive devices such as intrauterine devices should be considered as first line therapy;
• After the surgery, women should undergo close monitoring for nutritional deficiencies before, during and after pregnancy. Expert opinion recommends these women undergo dietary assessment and supplementation to prevent micronutrient deficiencies. Protein, iron, folate, calcium, and vitamins B12 and D are the most common nutrient deficiencies after gastric bypass surgery. If no deficits are noted, a complete blood count and measurement of iron, ferritin, calcium, and vitamin D levels every trimester should be considered.
• Bariatric surgeons, medical practitioners, dieticians, the patient’s usual general practitioner, obstetricians, and maternity specialists should be involved to assist in the multidisciplinary management of these complex patients.

Labor and Delivery

Bariatric surgery should not affect the management of labor and delivery. Although rates of cesarean delivery are higher in women who have had bariatric surgery, it is not an indication of cesarean delivery. If a patient has had extensive and complicated abdominal surgery from weight-loss procedures, pre-labor consultation with a bariatric surgeon should be considered.

It is important that these women are managed early on in the prenatal period with a multidisciplinary team beyond the traditional obstetricians and maternity specialists to also involve bariatric surgeons, bariatric medical practitioners, bariatric dieticians, and the patient’s usual GP to improve pregnancy-related outcomes.

Ref: https://www.aafp.org/

Disclaimer