Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-16T23:55:47.766Z Has data issue: false hasContentIssue false

17 - Pre-pregnancy bariatric surgery: improved fertility and pregnancy outcome?

from Section 4 - Interventions

Published online by Cambridge University Press:  05 August 2012

By
Roland G. Devlieger  and
Isabelle Guelinckx
Edited by
Matthew W. Gillman  and
Lucilla Poston
Matthew W. Gillman
Affiliation:
Harvard Medical School
Lucilla Poston
Affiliation:
King's College London
Get access

Summary

Introduction

Ideally interventions to improve pregnancy outcome in obese women should start in the preconceptional period. Lifestyle changes leading toward a negative energy balance (energy intake < energy expenditure) and consequently to weight loss are advisable as a first step. However, the effectiveness of these lifestyle interventions in non-pregnant adults to maintain the induced weight loss in the long term is low, even if these conventional actions are supported by pharmacotherapy. In relation to morbid obesity, bariatric surgery, also known as obesity surgery, offers a more effective treatment: it results in a substantial weight loss that is sustainable in the long term and in improvement of obesity-associated co-morbidities [1,2]. A surgical intervention is therefore increasingly being considered when conventional interventions have failed in patients with a body mass index (BMI) of more than 40kg/m² and for those with a BMI of over 35kg/m² with co-morbidities such as sleep apnea, diabetes, joint disease, and cardiopulmonary problems [3].

As obesity rates rise worldwide, so have the number of bariatric operations and in the number of practicing bariatric surgeons [4,5]. In 2008 approximately 220000 people with morbid obesity underwent bariatric surgery in the USA and Canada [6]. About 85% of all bariatric surgery patients are women of reproductive age [5]. Additionally, an increasing number of adolescents, predominantly female, are having bariatric surgery [7]. Consequently, health care providers will increasingly be confronted with pregnant women with a medical history of bariatric surgery.

Keywords

bariatric surgeryendocrinologistsfemale reproductive functionspregnancyprenatal periodpediatriciansnutritional deficienciesobstetricianssurgeons
Type
Chapter
Information
Maternal Obesity , pp. 209 - 222
Publisher: Cambridge University Press
Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Picot, J Jones, J Colquitt, J L The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation Health Technol Assess 2009 13 1 Google Scholar
Colquitt, J L Picot, J Loveman, E Surgery for obesity Cochrane Database Syst Rev 2009 2 Google Scholar
Anon, NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel Ann Intern Med 1991 115 956 Google Scholar
World Health Organization 2006
Samuel, I Mason, E E Renquist, K E Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry Am J Surg 2006 192 657 Google Scholar
Buchwald, H Oien, D M Metabolic/bariatric surgery worldwide 2008 Obes Surg 2009 19 1605 Google Scholar
Schilling, P L Davis, M M Albanese, C T National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence J Am Coll Surg 2008 206 1 Google Scholar
Livingston, E H Obesity and its surgical management Am J Surg. 2002 184 103 Google Scholar
Sjostrom, L Narbro, K Sjostrom, C D Effects of bariatric surgery on mortality in Swedish obese subjects N Engl J Med 2007 357 741 Google Scholar
Buchwald, H Avidor, Y Braunwald, E Bariatric surgery: a systematic review and meta-analysis JAMA 2004 292 1724 Google Scholar
Buchwald, H. Consensus conference statement. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers Surg Obes Relat Dis 2005 1 371 Google Scholar
Woodard, C B Pregnancy following bariatric surgery J Perinat Neonatal Nurs 2004 18 329 Google Scholar
Shankar, P Boylan, M Sriram, K. Micronutrient deficiencies after bariatric surgery Nutrition 2010 26 1031 Google Scholar
Stocker, D J Management of the bariatric surgery patient Endocrinol Metab Clin North Am 2003 32 437 Google Scholar
Avinoah, E Ovnat, A Charuzi, I. Nutritional status seven years after Roux-en-Y gastric bypass surgery Surgery 1992 111 137 Google Scholar
Guelinckx, I Devlieger, R Vansant, G. Reproductive outcome after bariatric surgery: a critical review Hum Reprod Update 2009 15 189 Google Scholar
Poitou Bernert, C Ciangura, C Coupaye, M Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment Diabetes Metab 2007 33 13 Google Scholar
Apovian, C M Baker, C Ludwig, D S Best practice guidelines in pediatric/adolescent weight loss surgery Obes Res 2005 13 274 Google Scholar
Colles, S L Dixon, J B O’Brien, P E Hunger control and regular physical activity facilitate weight loss after laparoscopic adjustable gastric banding Obes Surg 2008 18 833 Google Scholar
Hwang, K O Childs, J H Goodrick, G K Explanations for unsuccessful weight loss among bariatric surgery candidates Obes Surg 2009 19 1377 Google Scholar
Tucker, O N Szomstein, S Rosenthal, R J Nutritional consequences of weight-loss surgery Med Clin North Am 2007 91 499 Google Scholar
Merhi, Z O Impact of bariatric surgery on female reproduction Fertil Steril 2009 92 1501 Google Scholar
Shah, D K Ginsburg, E S Bariatric surgery and fertility Curr Opin Obstet Gynecol 2010 22 248 Google Scholar
Teitelman, M Grotegut, C A Williams, N N The impact of bariatric surgery on menstrual patterns Obes Surg 2006 16 1457 Google Scholar
Cools, M Duval, E L Jespers, A. Adverse neonatal outcome after maternal biliopancreatic diversion operation: report of nine cases Eur J Pediatr 2006 165 199 Google Scholar
Adami, G F Friedman, D Cuneo, S Intravenous nutritional support in pregnancy. Experience following biliopancreatic diversion Clin Nutr 1992 11 106 Google Scholar
Granstrom, L Backman, L. Fetal growth retardation after gastric banding Acta Obstet Gynecol Scand 1990 69 533 Google Scholar
Gurewitsch, E D Smith-Levitin, M Mack, J. Pregnancy following gastric bypass surgery for morbid obesity Obstet Gynecol 1996 88 658 Google Scholar
Martens, W S Martin, L F Berlin, C M Failure of a nursing infant to thrive after the mother’s gastric bypass for morbid obesity Pediatrics 1990 86 777 Google Scholar
Weissman, A Hagay, Z Schachter, M Severe maternal and fetal electrolyte imbalance in pregnancy after gastric surgery for morbid obesity. A case report J Reprod Med 1995 40 813 Google Scholar
Eerdekens, A Debeer, A Van Hoey, G Maternal bariatric surgery: adverse outcomes in neonates Eur J Pediatr 2009 169 191 Google Scholar
Van Mieghem, T Van Schoubroeck, D Depiere, M Fetal cerebral hemorrhage due to vitamin K deficiency after complicated bariatric surgery Obstet Gynecol 2008 112 434 Google Scholar
Campbell, C D Ganesh, J Ficicioglu, C. Two newborns with nutritional vitamin B12 deficiency: challenges in newborn screening for vitamin B12 deficiency Haematologica 2005 90 45 Google Scholar
Celiker, M Y Chawla, A. Congenital B12 deficiency following maternal gastric bypass J Perinatol 2009 29 640 Google Scholar
Grange, D K Finlay, J L Nutritional vitamin B12 deficiency in a breastfed infant following maternal gastric bypass Pediatr Hematol Oncol 1994 11 311 Google Scholar
Wardinsky, T D Montes, R G Friederich, R L Vitamin B12 deficiency associated with low breast-milk vitamin B12 concentration in an infant following maternal gastric bypass surgery Arch Pediatr Adolesc Med 1995 149 1281 Google Scholar
Friedman, D Cuneo, S Valenzano, M Pregnancies in an 18-year follow-up after biliopancreatic diversion Obes Surg 1995 5 308 Google Scholar
Bennett, W L Gilson, M M Jamshidi, R Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data BMJ 2010 340 c1662 Google Scholar
Maggard, M A Yermilov, I Li, Z Pregnancy and fertility following bariatric surgery: a systematic review JAMA 2008 300 2286 Google Scholar
Dixon, J B Dixon, M E O’Brien, P E Birth outcomes in obese women after laparoscopic adjustable gastric banding Obstet Gynecol 2005 106 965 Google Scholar
Ducarme, G Revaux, A Rodrigues, A Obstetric outcome following laparoscopic adjustable gastric banding Int J Gynaecol Obstet 2007 98 244 Google Scholar
Wittgrove, A C Jester, L Wittgrove, P Pregnancy following gastric bypass for morbid obesity Obes Surg 1998 8 461 Google Scholar
Dao, T Kuhn, J Ehmer, D Pregnancy outcomes after gastric-bypass surgery Am J Surg 2006 192 762 Google Scholar
Printen, K J Scott, D. Pregnancy following gastric bypass for the treatment of morbid obesity Am Surg 1982 48 363 Google Scholar
Efthimiou, E Stein, L Court, O Internal hernia after gastric bypass surgery during middle trimester pregnancy resulting in fetal loss: risk of internal hernia never ends Surg Obes Relat Dis 2009 5 378 Google Scholar
Torres-Villalobos, G M Kellogg, T A Leslie, D B Small bowel obstruction and internal hernias during pregnancy after gastric bypass surgery Obes Surg 2009 19 944 Google Scholar
Gagne, D J DeVoogd, K Rutkoski, J D Laparoscopic repair of internal hernia during pregnancy after Roux-en-Y gastric bypass Surg Obes Relat Dis 2010 6 88 Google Scholar
Gazzalle, A Braun, D Cavazzola, L T Late intestinal obstruction due to an intestinal volvulus in a pregnant patient with a previous Roux-en-Y gastric bypass Obes Surg 2010 20 1740 Google Scholar
Naef, M Mouton, W G Wagner, H E Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass Obes Surg 2010 20 1737 Google Scholar
Rosenkrantz, A B Kurian, M Kim, D. MRI appearance of internal hernia following Roux-en-Y gastric bypass surgery in the pregnant patient Clin Radiol 2010 65 246 Google Scholar
Wax, J R Wolff, R Cobean, R Intussusception complicating pregnancy following laparoscopic Roux-en-Y gastric bypass Obes Surg 2007 17 977 Google Scholar
Kakarla, N Dailey, C Marino, T Pregnancy after gastric bypass surgery and internal hernia formation Obstet Gynecol 2005 105 1195 Google Scholar
Weiss, HG Nehoda, H Labeck, B Pregnancies after adjustable gastric banding Obes Surg 2001 11 303 Google Scholar
Gaudry, P Mognol, P Fortin, A Reflection on one case of acute peritonitis due to adjustable gastric banding during pregnancy Gynecol Obstet Fertil 2006 34 407 Google Scholar
Patel, J A Patel, N A Thomas, R L Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass Surg Obes Relat Dis 2008 4 39 Google Scholar
Skull, A J Slater, G H Duncombe, J E Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes Obes Surg 2004 14 230 Google Scholar
Merhi, Z O Pal, L. Effect of weight loss by bariatric surgery on the risk of miscarriage Gynecol Obstet Invest 2007 64 224 Google Scholar
Sheiner, E Levy, A Silverberg, D Pregnancy after bariatric surgery is not associated with adverse perinatal outcome Am J Obstet Gynecol 2004 190 1335 Google Scholar
Weintraub, A Y Levy, A Levi, I Effect of bariatric surgery on pregnancy outcome Int J Gynaecol Obstet 2008 103 246 Google Scholar
Haddow, J E Hill, LE Kloza, E M Neural tube defects after gastric bypass Lancet 1986 1 1330 Google Scholar
Martin, L Chavez, G F Adams, M J Gastric bypass surgery as maternal risk factor for neural tube defects Lancet 1988 1 640 Google Scholar
Marceau, P Kaufman, D Biron, S Outcome of pregnancies after biliopancreatic diversion Obes Surg 2004 14 318 Google Scholar
American College of Obstetricians and Gynecologists ACOG practice bulletin no. 105: bariatric surgery and pregnancy Obstet Gynecol 2009 113 1405 Google Scholar
Painter, R C Roseboom, T J Bleker, O P Prenatal exposure to the Dutch famine and disease in later life: an overview Reprod Toxicol 2005 20 345 Google Scholar
Haward, R N Brown, W A O’Brien, P E Does pregnancy increase the need for revisional surgery after laparoscopic adjustable gastric banding? Obes Surg 2011 21 1362 Google Scholar
Nomura, R M Dias, M C Igai, A M Anemia during pregnancy after silastic ring Roux-en-Y gastric bypass: influence of time to conception Obes Surg 2011 21 479 Google Scholar
Bal, B S Finelli, F C Koch, T R Origins of and recognition of micronutrient deficiencies after gastric bypass surgery Curr Diab Rep 2011 11 136 Google Scholar
Sheiner, E Edri, A Balaban, E Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery Am J Obstet Gynecol 2011 204 50e1 Google Scholar
Wax, J R Cartin, A Wolff, R Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes Obes Surg 2008 18 1517 Google Scholar
Roehrig, H R Xanthakos, S A Sweeney, J Pregnancy after gastric bypass surgery in adolescents Obes Surg 2007 17 873 Google Scholar
Paulen, M E Zapata, L B Cansino, C Contraceptive use among women with a history of bariatric surgery: a systematic review Contraception 2010 82 86 Google Scholar
World Health Organization 2008 www.who.int/reproductivehealth/topics/family_planning/updates/en/
Coates, P S Fernstrom, J D Fernstrom, M H Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass J Clin Endocrinol Metab 2004 89 1061 Google Scholar
Wax, J R Heersink, D Pinette, M G Symptomatic hypoglycemia complicating pregnancy following Roux-en-Y gastric bypass surgery Obes Surg 2007 17 698 Google Scholar
American Diabetes Association Gestational diabetes mellitus. Practice guideline Diabetes Care 2004 27 s88 Google Scholar
Institute of Medicine Weight Gain During Pregnancy: Reexamining the Guidelines Washington, DC The National Academies Press 2009
Centers for Disease Control and Prevention CDC Grand Rounds: additional opportunities to prevent neural tube defects with folic acid fortification MMWR Morb Mortal Wkly Rep 2010 59 980 Google Scholar
Dixon, J B Dixon, M E O’Brien, P E Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level Int J Obes Relat Metab Disord 2001 25 219 Google Scholar
Bar-Zohar, D Azem, F Klausner, J Abu-Abeid, S. Pregnancy after laparoscopic adjustable gastric banding: perinatal outcome is favorable also for women with relatively high gestational weight gain Surg Endosc 2006 20 1580 Google Scholar
Bilenka, B Ben-Shlomo, I Cozacov, C Gold, C H Zohar, S. Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity Acta Obstet Gynecol Scand 1995 74 42 Google Scholar
Richards, D S Miller, D K Goodman, G N Pregnancy after gastric bypass for morbid obesity J Reprod Med 1987 32 172 Google Scholar
Landsberger, E Ankrah, Y Segal-Isaacson, CJ Should severely obese women complete childbearing prior to bariatric surgery? Am J Obstet Gynecol 2006 195 S93 Google Scholar
Nomura, R M Dias, M C Igai, A M Paiva, L V Zugaib, M. Anemia during pregnancy after silastic ring Roux-en-Y gastric bypass: influence of time to conception Obes Surg 2011 21 479 Google Scholar
Kral, J G Biron, S Simard, S Large maternal weight loss from obesity surgery prevents transmission of obesity to children who were followed for 2 to 18 years Pediatrics 2006 118 e1644 Google Scholar
Deitel, M Stone, E Kassam, H A Wilk, E J Sutherland, D J Gynecologic–obstetric changes after loss of massive excess weight following bariatric surgery J Am Coll Nutr 1988 7 147 Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×