#105 Bariatric Surgery and Pregnancy Flashcards
What prepregnancy BMI or weight in pounds can be used to stratify risk during pregnancy (increased risk vs not at increased risk)?
BMI of more than 30 or a prepregnancy weight of more than 200lbs
How do you calculate BMI?
Weight in kg divided by height in meters squared
Does obesity affect ferility? If yes, in what way(s)?
Decreases fertility primarily as a result of oligo-ovulation and anovulation
Are obese women more or less likely to respond to ovulation induction?
Less likely even with higher doses of gonadotropins
In pregnancy, what additional maternal risks occur in obese patients?
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).
Are obese patients more likely to have spontaneous preterm labor?
No
What are increased risks regarding cesarean section with obese patients?
Difficulty in establishing and recovery from region and general anesthesia, prolonged operating times, increased blood loss, higher risk of thromboembolism
What effects can maternal obesity have on the fetus?
Increased risks of congenital anomalies, growth anomalies, miscarriage, and stillbirth
What are the most common types of obesity-associated birth defects?
Neural tube, cardiac systems, and facial clefting
Are pregnancies affected by maternal obesity more likely to have SGA or LGA infants?
Most studies report an increase in LGA and macrosomic infants
What is the risk for stillbirth in the obese population compared to normal weight women?
Risk for stillbirth is 2.1-4.3 fold greater
Is maternal obesity associated with increased risk of subsequent childhood obesity?
Yes
What qualifies a patient for bariatric surgery?
BMI of 40 or more or those with a BMI of 35 or more and other comorbidities
What is the most effective therapy available for morbid obesity?
Bariatric surgery, results in improvement or complete resolution of comorbidities and improved quality of life
What are the two primary categories of bariatric surgery?
Either restrictive or combination of restrictive and malabsorptive operations
What are the two type of bariatric surgeries performed (names of procedures)?
Roux-en-Y gastric bypass (restrictive or malabsorptive) and adjustable gastric banding (restrictive)
How does bariatric surgery affect fertility?
Leads to higher fertility rates. (improving PCOS, anovulation, and irregular menses)
Should bariatric surgery be considered a treatment for infertility?
No
How does PSH of Roux-en-Y gastric bypass affect your contraceptive counseling?
Not a great candidate for OCPs. Increased risk of unintended pregnancies. Suspected decreased absorption after malabsorptive surgery
Does Roux-en-Y gastric bypass decrease the rate of HTN in pregnancy?
Yes (45.6% during pregnancy prior to surgery, 8.7% during pregnancy after surgery)
Does bariatric surgery decrease the occurence of pregestational diabetes?
Yes
Does bariatric surgery decrease the rate of gestational diabetes?
Yes
Does bariatric surgery decrease the rate of preeclampsia?
Yes
What are some late complications of previous bariatric surgery that can occur during pregnancy?
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
Does bariatric surgery increase the rate of congenital anomalies compared to general population?
No
Is bariatric surgery associated with increase in perinatal death?
No
What is relationship between Roux-en-Y gastric bypass and macrosomia?
Rate of macrosomia was decreased
How do pregnancy rates in adolescent population compare between post bariatric surgery and general adolescent population?
Doubled (12.8% vs 6.4%)
How long after bariatric surgery should a woman wait to become pregnant? Why?
12-24 months. To avoid exposing fetus to rapid maternal weight loss.
What are the most common nutritional deficiencies after Roux-en-Y gastric bypass surgery?
Protein, iron, vitamin B12, folate, vitamin D, and calcium
What additional lab monitoring can be considered for pregnant women w/ PSH Roux-en-Y gastric bypass?
CBC, iron, ferritin, calcium, and vitamin D levels every trimester
What is the daily recommendation for protein intake? Is it higher or lower with bariatric surgery?
60g. Same after bariatric surgery.
What is the maxiumum dosing of vitamin A during pregnancy? Why?
5,000 IU per day. Excess vitamin A consumption during pregnancy is associated with birth defects
Do breast-fed infants of mothers s/p bariatric surgery have increased risk of nutritional deficiencies?
Yes, increased risk of nutritional deficiencies
What are the symptoms of dumping syndrome?
Abdominal cramps, bloating, nausea, vomiting, and diarrhea
What causes dumping syndrome?
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)
What are potential consequences of dumping syndrome?
Hyperinsulinemia w/ consequent hypoglycemia resulting in tachycardia, palpitations, anxiety, and diaphoresis
How do you screen for gestational diabetes in a patient with history of bariatric surgery?
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
What is the preferred type of medication for patients s/p Roux-en-Y gastric bypass: extended-release preparations or rapid release?
Rapid release. Absorptive surface area of intestine is decreased (decreased time for absorption, not enough time for extended release)
Does history of bariatric surgery alter the course of labor and delivery?
No