A new study published today says that women who undergo bariatric surgery should take additional care when planning a pregnancy.

They say they may have to wait 12-18 months before having a baby.

According to the authors of a narrative review published today in the Medical Journal of Australia, women who have bariatric surgery should be monitored in the perinatal period by a multidisciplinary team to improve pregnancy-related outcomes.

Obesity raises the risk of infertility in both men and women and reduces the efficacy of reproductive treatments, according to the new study, led by Dr Sarah Cheah of Sydney’s St George Hospital. Obesity raises the risk of fetal morbidity and mortality, as well as maternal pregnancy problems and the likelihood of a difficult delivery.

“Bariatric surgery generally leads to more than 20% of total body weight loss, which is sufficient to ameliorate polycystic ovary syndrome, diabetes and hypertension,” Cheah and colleagues write in their paper. “It has been shown to improve fertility and pregnancy-related outcomes for mother and child.

“However, in the absence of well constructed trials, bariatric surgery for fertility reasons has to be prescribed on a case-by-case basis. Almost 60% 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.”

Following an evaluation of the evidence, Cheah and colleagues made the following recommendations:

• Due to the negative pregnancy outcomes associated with rapid weight loss, pregnancy should be postponed for at least 12–18 months after bariatric surgery;

• Although the effectiveness of the oral contraceptive pill may be compromised as a result of malabsorption, contraceptive devices such as intrauterine devices should be considered first line therapy after bariatric surgery;

• Women who have had bariatric surgery should be closely monitored for nutritional deficiencies before, during, and after pregnancy. According to experts, these women should have their diets assessed and supplemented to avoid nutritional deficiencies; and,

• To aid in the multidisciplinary management of these difficult patients, bariatric surgeons, bariatric medical practitioners, bariatric dieticians, the patient’s usual general practitioner, obstetricians, and maternity experts should be included.

“Post-bariatric surgery pregnant women are at increased risk of nutritional insufficiencies during their pregnancy and of preterm or small for gestational age fetuses,” Cheah and colleagues conclues.

“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.”

Source: 10.5694/mja2.51373

Image Credit: Getty

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