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Practice bulletins > #105 Bariatric Surgery and Pregnancy > Flashcards

#105 Bariatric Surgery and Pregnancy Flashcards

1
Q

What prepregnancy BMI or weight in pounds can be used to stratify risk during pregnancy (increased risk vs not at increased risk)?

A

BMI of more than 30 or a prepregnancy weight of more than 200lbs

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2
Q

How do you calculate BMI?

A

Weight in kg divided by height in meters squared

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3
Q

Does obesity affect ferility? If yes, in what way(s)?

A

Decreases fertility primarily as a result of oligo-ovulation and anovulation

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4
Q

Are obese women more or less likely to respond to ovulation induction?

A

Less likely even with higher doses of gonadotropins

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5
Q

In pregnancy, what additional maternal risks occur in obese patients?

A

Increased risks for gestational diabetes, preeclampsia, cesarean delivery, infectious morbidity, less likely to have VBAC, higher incidence of preterm birth (indicated, less likely to have spontaneous preterm labor).

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6
Q

Are obese patients more likely to have spontaneous preterm labor?

A

No

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7
Q

What are increased risks regarding cesarean section with obese patients?

A

Difficulty in establishing and recovery from region and general anesthesia, prolonged operating times, increased blood loss, higher risk of thromboembolism

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8
Q

What effects can maternal obesity have on the fetus?

A

Increased risks of congenital anomalies, growth anomalies, miscarriage, and stillbirth

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9
Q

What are the most common types of obesity-associated birth defects?

A

Neural tube, cardiac systems, and facial clefting

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10
Q

Are pregnancies affected by maternal obesity more likely to have SGA or LGA infants?

A

Most studies report an increase in LGA and macrosomic infants

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11
Q

What is the risk for stillbirth in the obese population compared to normal weight women?

A

Risk for stillbirth is 2.1-4.3 fold greater

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12
Q

Is maternal obesity associated with increased risk of subsequent childhood obesity?

A

Yes

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13
Q

What qualifies a patient for bariatric surgery?

A

BMI of 40 or more or those with a BMI of 35 or more and other comorbidities

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14
Q

What is the most effective therapy available for morbid obesity?

A

Bariatric surgery, results in improvement or complete resolution of comorbidities and improved quality of life

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15
Q

What are the two primary categories of bariatric surgery?

A

Either restrictive or combination of restrictive and malabsorptive operations

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16
Q

What are the two type of bariatric surgeries performed (names of procedures)?

A

Roux-en-Y gastric bypass (restrictive or malabsorptive) and adjustable gastric banding (restrictive)

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17
Q

How does bariatric surgery affect fertility?

A

Leads to higher fertility rates. (improving PCOS, anovulation, and irregular menses)

18
Q

Should bariatric surgery be considered a treatment for infertility?

A

No

19
Q

How does PSH of Roux-en-Y gastric bypass affect your contraceptive counseling?

A

Not a great candidate for OCPs. Increased risk of unintended pregnancies. Suspected decreased absorption after malabsorptive surgery

20
Q

Does Roux-en-Y gastric bypass decrease the rate of HTN in pregnancy?

A

Yes (45.6% during pregnancy prior to surgery, 8.7% during pregnancy after surgery)

21
Q

Does bariatric surgery decrease the occurence of pregestational diabetes?

A

Yes

22
Q

Does bariatric surgery decrease the rate of gestational diabetes?

A

Yes

23
Q

Does bariatric surgery decrease the rate of preeclampsia?

A

Yes

24
Q

What are some late complications of previous bariatric surgery that can occur during pregnancy?

A

Maternal intestinal obstruction, gastrointestinal hemorrhage, anastomotic leaks, internal hernias, ventral hernias, band erosion, band migration

**Important to keep high index of suspicion for GI surgical complications when these women present with significant abdominal symptoms

25
Q

Does bariatric surgery increase the rate of congenital anomalies compared to general population?

A

No

26
Q

Is bariatric surgery associated with increase in perinatal death?

A

No

27
Q

What is relationship between Roux-en-Y gastric bypass and macrosomia?

A

Rate of macrosomia was decreased

28
Q

How do pregnancy rates in adolescent population compare between post bariatric surgery and general adolescent population?

A

Doubled (12.8% vs 6.4%)

29
Q

How long after bariatric surgery should a woman wait to become pregnant? Why?

A

12-24 months. To avoid exposing fetus to rapid maternal weight loss.

30
Q

What are the most common nutritional deficiencies after Roux-en-Y gastric bypass surgery?

A

Protein, iron, vitamin B12, folate, vitamin D, and calcium

31
Q

What additional lab monitoring can be considered for pregnant women w/ PSH Roux-en-Y gastric bypass?

A

CBC, iron, ferritin, calcium, and vitamin D levels every trimester

32
Q

What is the daily recommendation for protein intake? Is it higher or lower with bariatric surgery?

A

60g. Same after bariatric surgery.

33
Q

What is the maxiumum dosing of vitamin A during pregnancy? Why?

A

5,000 IU per day. Excess vitamin A consumption during pregnancy is associated with birth defects

34
Q

Do breast-fed infants of mothers s/p bariatric surgery have increased risk of nutritional deficiencies?

A

Yes, increased risk of nutritional deficiencies

35
Q

What are the symptoms of dumping syndrome?

A

Abdominal cramps, bloating, nausea, vomiting, and diarrhea

36
Q

What causes dumping syndrome?

A

In someone who has had gastric bypass it is related to ingestion of refined sugars or high glycemic carbohydrates that are rapidly emptied into small intestine leading to fluid shifts (intravascular > bowel lumen)

37
Q

What are potential consequences of dumping syndrome?

A

Hyperinsulinemia w/ consequent hypoglycemia resulting in tachycardia, palpitations, anxiety, and diaphoresis

38
Q

How do you screen for gestational diabetes in a patient with history of bariatric surgery?

A

Patient with malabsorptive surgery may have dumping syndrome (unable to tolerate 50g glucose load). Can monitor FSG at home for 1 week between 24-28wks

39
Q

What is the preferred type of medication for patients s/p Roux-en-Y gastric bypass: extended-release preparations or rapid release?

A

Rapid release. Absorptive surface area of intestine is decreased (decreased time for absorption, not enough time for extended release)

40
Q

Does history of bariatric surgery alter the course of labor and delivery?

A

No

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