bariatric surgery in pregnancy

Question 1

what are the two types of bariatric surgery?

Answer 1

• restrictive (sleeve gastrectomy, adjustable gastric band)

- malabsorptive + restrictive (roux-en-y gastric bypass)

Question 2

pregnancy weight gain goals by BMI category

Answer 2

BMI < 25: 25 to 35 pounds
25-29.9: 15-25 lbs
30+: 11-20 lbs

Question 3

normal caloric intake in pregnancy

protein requirment

Answer 3

2200-2900 cal/day

60 g/day

Question 4

common nutrients that are deficient (esp with RNY, but can be with all)

Answer 4

• protein
• iron
• B12
• folate
• vitamin D
• calcium

Question 5

considerations for medication dosing in pts with RNY

Answer 5

• avoid extended release medications
• avoid NSAIDs
• may need to monitor dosing of certain medications

Question 6

what is dumping syndrome? main consideration with pregnancy?

Answer 6

RNY pts ingest refined sugars/high glycemic index carbs causing intracellular fluid shifts into bowel lumen -> n/v, diarrhea, pain.

instead of 50 g gtt, do 5-7 days of home monitoring of: 2 hr pp and fasting

Question 7

abd pain/GI sx in pregnant pt with prior bariatric surgery

Answer 7

• need to rule out issues related to surgery (i.e. anastamotic leak, hernia, small bowel obstruction etc)

Question 8

contraception in these patients

Answer 8

• decreased efficacy of OCPs
• prefer non-oral hormonal contraceptives

higher fertility rates after bariatric surgery; but should never be considered treatment for infertility