Outcomes in pregnancy following bariatric surgery

Given the large number of complications that are associated with obesity in pregnancy there is considerable advantage to determining weight-loss solutions that favorably affect fertility status and fetal outcomes. In this chapter we have presented evidence that bariatric surgery may be a safe and effective method to help achieve weight loss in patients wishing to conceive. There are no statistically significant adverse perinatal or fetal outcomes in postbariatric pregnancies. Benefits of postbariatric pregnancies include decreased rates of hypertensive disorders and gestational diabetes mellitus in comparison with preoperative and obese cohorts. Additionally, fertility status may improve following bariatric surgery, especially if the weight loss is marked. For those patients who look to avoid pregnancy, clinicians should suggest alternative forms of birth control for those taking oral contraceptives until more comprehensive studies are performed. Despite the relatively good safety profile of postbariatric pregnancies, increased rates of small-for-gestational-age and intrauterine growth restriction have been documented in the postbariatric surgery population. Although the evidence is not conclusive, it is well advised to monitor fetal growth throughout gestation. Babies born to postbariatric surgery mothers are not at decreased risk for macrosomia compared with obese parturient, therefore these pregnancies should be monitored to ensure that secondary risks of macrosomia such as shoulder dystocia are avoided. However, clinicians should be careful to ensure that they do not refer postbariatric patients to cesarean section based on postbariatric status alone as postbariatric status is not an indication for cesarean section. Postbariatric patients should be monitored throughout their pregnancy for nutritional deficiencies. Guidelines suggest testing for protein, iron, calcium, vitamin B12 and vitamin D during the first trimester especially following malabsorptive procedures. Although more studies must be performed the current evidence suggests that if postbariatric pregnancies are managed properly the benefits may outweigh the risks considerably.