PDF herunterladen
CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences
DOI: 10.1055/s-0044-1779631
Review Article

Fertility and Pregnancy after Bariatric Surgery: Challenges and Solutions

Angeliki Mina
1   Department of Gynecology and Obstetrics and Medicine, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
,
Amna Asraiti
2   Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
,
Elamin Abdelgadir
2   Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
› Institutsangaben Funding None
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Introduction Obesity is increasing worldwide, and bariatric surgery (BS) is increasingly employed for weight management in women of reproductive age. An interplay between pregnancy and BS is very likely. A review of the challenges faced and solutions needed is warranted.

Materials and Methods A narrative, nonsystematic review of the international literature from a single online database (PubMed) was performed on July 23, 2023. All articles were included. The retrieved relevant literature is narrated in a concise thematic account.

Results BS carries major metabolic, mechanical, and vascular benefits, possibly accompanied by nutritional, vitamins, minerals, and micronutrient deficiencies, which might be clinical or subclinical. A few of the frequently reported postbariatric nutritional jeopardies could be augmented by the physiological changes of pregnancy, which need a different approach to management. Nutritional deficiencies during pregnancy could carry both maternal and fetal short- and long-term risks. Fetal risks may range from miscarriage to low birth weight, neural tube defects, congenital anomalies, cognitive impairment, and internal organ dysplasia. Postbariatric status is, by default, a high-risk pregnancy category, given the altered biochemical, vasomotor, and mechanical indices of any lady treated with BS. Postgastric bypass hypoglycemia (PGBH) is a relatively common phenomenon during pregnancy, and it usually calls for multidisciplinary action to control. A dedicated monitoring protocol before, during, and after pregnancy has been suggested in several guidelines to guard against the potentially devastating consequences to both mother and fetus.

Conclusions Weight reduction after BS enhances fertility. The optimum timing for ladies treated with BS to get pregnant is not very well established yet. However, various societies have provided multidisciplinary management guidance of management prior to and during pregnancy. Many nutritional supplements that are not routinely prescribed during pregnancy will be essential for those treated with BS. Further studies are still warranted to ensure the safe interim between BS and conception as well as the safety of various doses of medications used for postbariatric individuals, for instance, medications used for PGBH.

Keywords

Obesity - Pregnancy - bariatric surgery - fetal outcome - maternal outcome - malnutrition - dietary modifications

Author Contributions

A.M. drafted the first version of the manuscript. All other authors read and approved the final version.


Compliance with Ethical Principles

Not applicable




Publikationsverlauf

Artikel online veröffentlicht:
08. Mai 2024

© 2024. The Libyan Biotechnology Research Center. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 WHO. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. WHO Technical Report Series, 894. 2000
    PubMedGoogle Scholar
  • 2 Lin X, Li H. Obesity: epidemiology, pathophysiology, and therapeutics. Front Endocrinol (Lausanne) 2021; 12: 706978
    CrossrefPubMedGoogle Scholar
  • 3 D'Souza R, Horyn I, Pavalagantharajah S, Zaffar N, Jacob CE. Maternal body mass index and pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol MFM 2019; 1 (04) 100041
    CrossrefPubMedGoogle Scholar
  • 4 Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311 (15) 1536-1546
    CrossrefPubMedGoogle Scholar
  • 5 Fernández-Sánchez A, Madrigal-Santillán E, Bautista M. et al. Inflammation, oxidative stress, and obesity. Int J Mol Sci 2011; 12 (05) 3117-3132
    CrossrefPubMedGoogle Scholar
  • 6 Sowers JR, Whaley-Connell A, Hayden MR. The role of overweight and obesity in the cardiorenal syndrome. Cardiorenal Med 2011; 1 (01) 5-12
    CrossrefPubMedGoogle Scholar
  • 7 La Vignera S, Condorelli R, Bellanca S. et al. Obesity is associated with a higher level of proinflammatory cytokines in women undergoing medically assisted procreation (PMA) programs in follicular fluid. Eur Rev Med Pharmacol Sci 2011; 356: 267-273
    Google Scholar
  • 8 Kominiarek MA, Chauhan SP. Obesity before, during, and after pregnancy: a review and comparison of five national guidelines. Am J Perinatol 2016; 33 (05) 433-441
    PubMedGoogle Scholar
  • 9 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). 5th IFSO Global Registry Report [monograph on the Internet]. Naples, Italy: IFSO; 2019 [cited YYYY Mon D]. Accessed 23 January, 2024 at: https://www.ifso.com/pdf/5th-ifso-global-registry-report-september-2019.pdf
    PubMedGoogle Scholar
  • 10 Chouillard EK, Karaa A, Elkhoury M, Greco VJ. Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS). Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study. Surg Obes Relat Dis 2011; 7 (04) 500-505
    CrossrefPubMedGoogle Scholar
  • 11 Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ 2017; 356: j1
    CrossrefPubMedGoogle Scholar
  • 12 Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg 2014; 149 (03) 275-287
    CrossrefPubMedGoogle Scholar
  • 13 Al-Shehri F, Moqbel M, Al-Khaldi Y. et al. Prevention and management of obesity: Saudi guideline update. Saudi J Obes 2016; 4 (01) 25
    CrossrefGoogle Scholar
  • 14 Christ JP, Falcone T. Bariatric surgery improves hyperandrogenism, menstrual irregularities, and metabolic dysfunction among women with polycystic ovary syndrome (PCOS). Obes Surg 2018; 28 (08) 2171-2177
    CrossrefPubMedGoogle Scholar
  • 15 Skubleny D, Switzer NJ, Gill RS. et al. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Surg 2016; 26 (01) 169-176
    CrossrefPubMedGoogle Scholar
  • 16 Parent B, Martopullo I, Weiss NS. et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg 2017; 152 (02) 128-135
    CrossrefPubMedGoogle Scholar
  • 17 Farin W, Oñate FP, Plassais J. et al. Impact of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy on gut microbiota: a metagenomic comparative analysis. Surg Obes Relat Dis 2020; 16 (07) 852-862
    CrossrefPubMedGoogle Scholar
  • 18 Buchwald H, Estok R, Fahrbach K. et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122 (03) 248-256.e5
    CrossrefPubMedGoogle Scholar
  • 19 Fallatah AM, Babatin HM, Nassibi KM, Banweer MK, Fayoumi MN, Oraif AM. Maternal and neonatal outcomes among obese pregnant women in King Abdulaziz University Hospital: a retrospective single-center medical record review. Med Arh 2019; 73 (06) 425-432
    CrossrefPubMedGoogle Scholar
  • 20 Spradley FT, Palei AC, Granger JP. Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms. Am J Physiol Regul Integr Comp Physiol 2015; 309 (11) R1326-R1343
    CrossrefPubMedGoogle Scholar
  • 21 Valentino D, Sriram K, Shankar P. Update on micronutrients in bariatric surgery. Curr Opin Clin Nutr Metab Care 2011; 14 (06) 635-641
    CrossrefPubMedGoogle Scholar
  • 22 Busetto L, Dicker D, Azran C. et al. Obesity Management Task Force of the European Association for the Study of Obesity Released “Practical Recommendations for the Post-Bariatric Surgery Medical Management”. Obes Surg 2018; 28 (07) 2117-2121
    CrossrefPubMedGoogle Scholar
  • 23 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol 2008; 112 (01) 201-207
    CrossrefPubMedGoogle Scholar
  • 24 Jacobson JC, Aikins Murphy P. United States medical eligibility criteria for contraceptive use 2010: a review of changes. J Midwifery Womens Health 2011; 56 (06) 598-607
    CrossrefPubMedGoogle Scholar
  • 25 Jans G, Matthys C, Bogaerts A. et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Adv Nutr 2015; 6 (04) 420-429
    CrossrefPubMedGoogle Scholar
  • 26 ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol 2009; 113 (06) 1405-1413
    CrossrefPubMedGoogle Scholar
  • 27 Alwan NA, Hamamy H. Maternal iron status in pregnancy and long-term health outcomes in the offspring. J Pediatr Genet 2015; 4 (02) 111-123
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 28 Coupaye M, Legardeur H, Sami O, Calabrese D, Mandelbrot L, Ledoux S. Impact of Roux-en-Y gastric bypass and sleeve gastrectomy on fetal growth and relationship with maternal nutritional status. Surg Obes Relat Dis 2018; 14 (10) 1488-1494
    CrossrefPubMedGoogle Scholar
  • 29 Xanthakos SA. Nutritional deficiencies in obesity and after bariatric surgery. Pediatr Clin North Am 2009; 56 (05) 1105-1121
    CrossrefPubMedGoogle Scholar
  • 30 Kaska L, Kobiela J, Abacjew-Chmylko A. et al. Nutrition and pregnancy after bariatric surgery. ISRN Obes 2013; 2013: 492060
    PubMedGoogle Scholar
  • 31 Behere RV, Deshmukh AS, Otiv S, Gupte MD, Yajnik CS. Maternal vitamin b12 status during pregnancy and its association with outcomes of pregnancy and health of the offspring: a systematic review and implications for policy in India. Front Endocrinol (Lausanne) 2021; 12: 619176
    CrossrefPubMedGoogle Scholar
  • 32 Devlieger R, Guelinckx I, Jans G, Voets W, Vanholsbeke C, Vansant G. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study. PLoS One 2014; 9 (12) e114192
    CrossrefPubMedGoogle Scholar
  • 33 Amarasekera M, Prescott SL, Palmer DJ. Nutrition in early life, immune-programming and allergies: the role of epigenetics. Asian Pac J Allergy Immunol 2013; 31 (03) 175-182
    PubMedGoogle Scholar
  • 34 Cunninghan S, Cameron IT. Consequences of fetal growth restriction during childhood and adult life. Curr Obstet Gynaecol 2003; 13: 212-217
    CrossrefGoogle Scholar
  • 35 Shea MK, Booth SL, Gundberg CM. et al. Adulthood obesity is positively associated with adipose tissue concentrations of vitamin K and inversely associated with circulating indicators of vitamin K status in men and women. J Nutr 2010; 140 (05) 1029-1034
    CrossrefPubMedGoogle Scholar
  • 36 Bavaresco M, Paganini S, Lima TP. et al. Nutritional course of patients submitted to bariatric surgery. Obes Surg 2010; 20 (06) 716-721
    CrossrefPubMedGoogle Scholar
  • 37 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357 (03) 266-281
    CrossrefPubMedGoogle Scholar
  • 38 Chakhtoura MT, Nakhoul N, Akl EA, Mantzoros CS, El Hajj Fuleihan GA. Guidelines on vitamin D replacement in bariatric surgery: identification and systematic appraisal. Metabolism 2016; 65 (04) 586-597
    CrossrefPubMedGoogle Scholar
  • 39 Sass L, Vinding RK, Stokholm J. et al. High-dose vitamin d supplementation in pregnancy and neurodevelopment in childhood: a prespecified secondary analysis of a randomized clinical trial. JAMA Netw Open 2020; 3 (12) e2026018
    CrossrefPubMedGoogle Scholar
  • 40 Rumbold A, Duley L, Crowther C, Haslam R. Antioxidants for preventing pre-eclampsia. Cochrane Database Syst Rev 2005; (04) CD004227
    PubMedGoogle Scholar
  • 41 Kjaer MM, Nilas L. Pregnancy after bariatric surgery—-a review of benefits and risks. Acta Obstet Gynecol Scand 2013; 92 (03) 264-271
    CrossrefPubMedGoogle Scholar
  • 42 Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg 2008; 18 (08) 1023-1027
    CrossrefPubMedGoogle Scholar
  • 43 Germain A, Brunaud L. Visceral surgery and pregnancy. J Visc Surg 2010; 147 (03) e129-e135
    CrossrefPubMedGoogle Scholar
  • 44 Stentebjerg LL, Madsen LR, Støving RK. et al. Hypoglycemia in pregnancies following gastric bypass—a systematic review and meta-analysis. Obes Surg 2022; 32 (06) 2047-2055
    CrossrefPubMedGoogle Scholar
  • 45 Jasaitis Y, Sergent F, Bridoux V, Paquet M, Marpeau L, Ténière P. [Management of pregnancies after adjustable gastric banding]. J Gynecol Obstet Biol Reprod (Paris) 2007; 36 (08) 764-769
    PubMedGoogle Scholar
  • 46 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol 2013; 121 (01) 213-217
    CrossrefPubMedGoogle Scholar
  • 47 Maggard MA, Yermilov I, Li Z. et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA 2008; 300 (19) 2286-2296
    CrossrefPubMedGoogle Scholar
  • 48 Centers for Disease Control and Prevention (CDC). Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. MMWR Morb Mortal Wkly Rep 2011; 60 (26) 878-883
    PubMedGoogle Scholar
  • 49 Lopez LM, Bernholc A, Chen M. et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev 2016; 2016 (08) CD008452
    PubMedGoogle Scholar
  • 50 Busetto L, Dicker D, Azran C. et al. Practical recommendations of the obesity management task force of the European Association for the Study of obesity for the post-bariatric surgery medical management. Obes Facts 2017; 10 (06) 597-632
    CrossrefPubMedGoogle Scholar
  • 51 O'Kane M, Parretti HM, Pinkney J. et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev 2020; 21 (11) e13087
    CrossrefPubMedGoogle Scholar
  • 52 Rottenstreich A, Elazary R, Goldenshluger A, Pikarsky AJ, Elchalal U, Ben-Porat T. Maternal nutritional status and related pregnancy outcomes following bariatric surgery: a systematic review. Surg Obes Relat Dis 2019; 15 (02) 324-332
    CrossrefPubMedGoogle Scholar
  • 53 Smets KJ, Barlow T, Vanhaesebrouck P. Maternal vitamin A deficiency and neonatal microphthalmia: complications of biliopancreatic diversion?. Eur J Pediatr 2006; 165 (07) 502-504
    CrossrefPubMedGoogle Scholar
  • 54 Moliterno JA, DiLuna ML, Sood S, Roberts KE, Duncan CC. Gastric bypass: a risk factor for neural tube defects? Case report. J Neurosurg Pediatr 2008; 1 (05) 406-409
    CrossrefPubMedGoogle Scholar
  • 55 Van Mieghem T, Van Schoubroeck D, Depiere M, Debeer A, Hanssens M. Fetal cerebral hemorrhage caused by vitamin K deficiency after complicated bariatric surgery. Obstet Gynecol 2008; 112 (2 Pt 2): 434-436
    CrossrefPubMedGoogle Scholar
  • 56 Galazis N, Docheva N, Simillis C, Nicolaides KH. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014; 181: 45-53
    CrossrefPubMedGoogle Scholar
  • 57 Carreau AM, Nadeau M, Marceau S, Marceau P, Weisnagel SJ. Pregnancy after bariatric surgery: balancing risks and benefits. Can J Diabetes 2017; 41 (04) 432-438
    CrossrefPubMedGoogle Scholar
  • 58 Sheiner E, Menes TS, Silverberg D. et al. Pregnancy outcome of patients with gestational diabetes mellitus following bariatric surgery. Am J Obstet Gynecol 2006; 194 (02) 431-435
    CrossrefPubMedGoogle Scholar
  • 59 Feichtinger M, Stopp T, Hofmann S. et al. Altered glucose profiles and risk for hypoglycaemia during oral glucose tolerance testing in pregnancies after gastric bypass surgery. Diabetologia 2017; 60 (01) 153-157
    CrossrefPubMedGoogle Scholar
  • 60 Cosson E, Pigeyre M, Ritz P. Diagnosis and management of patients with significantly abnormal glycaemic profiles during pregnancy after bariatric surgery: PRESAGE (Pregnancy with significantly abnormal glycaemic exposure - bariatric patients). Diabetes Metab 2018; 44 (04) 376-379
    CrossrefPubMedGoogle Scholar
  • 61 Benhalima K, Minschart C, Ceulemans D. et al. Screening and management of gestational diabetes mellitus after bariatric surgery. Nutrients 2018; 10 (10) E1479
    CrossrefPubMedGoogle Scholar
  • 62 Petersen L, Lauenborg J, Svare J, Nilas L. The impact of upper abdominal pain during pregnancy following a gastric bypass. Obes Surg 2017; 27 (03) 688-693
    CrossrefPubMedGoogle Scholar
  • 63 Petrucciani N, Ciangura C, Debs T, Ducarme G, Calabrese D, Gugenheim J. BARIA-MAT Study Group. Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group. Surg Obes Relat Dis 2020; 16 (02) 312-331
    CrossrefPubMedGoogle Scholar
  • 64 Vrebosch L, Bel S, Vansant G, Guelinckx I, Devlieger R. Maternal and neonatal outcome after laparoscopic adjustable gastric banding: a systematic review. Obes Surg 2012; 22 (10) 1568-1579
    CrossrefPubMedGoogle Scholar
  • 65 Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks?. Am J Obstet Gynecol 2018; 218 (06) 573-580
    CrossrefPubMedGoogle Scholar
  • 66 Hazart J, Le Guennec D, Accoceberry M. et al. Maternal nutritional deficiencies and small-for-gestational-age neonates at birth of women who have undergone bariatric surgery. J Pregnancy 2017; 2017: 4168541
    CrossrefPubMedGoogle Scholar
  • 67 Celiker MY, Chawla A. Congenital B12 deficiency following maternal gastric bypass. J Perinatol 2009; 29 (09) 640-642
    CrossrefPubMedGoogle Scholar