Pregnancy and bariatric surgery - TOG article Flashcards
How long should patients wait to get pregnant following bariatric surgery?
12-18 months due to rapid weight loss and when nutritional deficiencies/electrolyte imbalance arises
Though evidence not different/conclusive re: outcomes
How many women who died of direct causes and indirect causes in 2006-2008 were overweight or obese?
Direct - 47%
Indirect - 50%
(Overall 49%)
What is the prevalence of obesity in women of reproductive age?
28%
What are the top 5 maternal and fetal risks in obese women by odds ratio?
Thromboembolism - 9.7 GDM - 3.6 Spontaneous abortion - 3.5 Shoulder dystocia - 3.14 Stillbirth - 2.79
When does NICE recommend bariatric surgery?
BMI >40 where lifestyle and/or medications have been found to be ineffective
What types of bariatric surgery are there?
Restrictive - *Laparoscopic adjustable gastric banding - Silastic ring - Vertical-banded gastroplasty - Sleeve gastrectomy Malabsorptive - Biliopancreatic diversion - Jejunoileal bypass Mixed - *Roux en Y gastric bypass
- lower complication rates. 5%
How many require fertility treatment following bariatric surgery?
6.7%
Which nutritional deficiencies are seen following surgery (particularly malabsorptive)?
B12* and folate* Plasma protein levels Iron* Calcium* Fat soluble vitamins - *supplements required
Also - dumping syndrome with excessive carb diet or GTT
Deficiency exacerbated by nausea and vomiting
What is the ideal gestational weight gain in pregnancy?
7-11kg
What are the surgical complications during pregnancy?
Band slippage and migration => vomiting
Band leakage 24%
Gastric prolapse 4% (needing removal at laparotomy)
Intestinal hernia (8%) and obstruction; perforation and death
Consider diagnosis when having pain and vomiting
How many women following surgery complete 37/40 and have uncomplicated pregnancies?
76 and 79% respectively
What are the OR for PET and chronic hypertension following surgery?
0.2 and 0.4 respectively
How should women be screened for GDM following bariatric surgery?
Fasting and 2 hr post prandial BMs at home for a week at 26-28/40
Does bariatric surgery reduce the rate of Caesarean?
No - ?caregiver bias
Infection risk
How does morbid obesity contribute to a reduction in breastfeeding?
Positional difficulties
Reduced prolactin response to suckling
Malabsorption in mum may affect energy content of milk ?PN growth affected (nutritional supplements to continue)
What are the perinatal outcomes following surgery?
?Higher incidence of spontaneous miscarriage
No difference in perinatal mortality rates or preterm births
?Reduced birthweight
Congenital malformations higher - diaphragmatic herina, intestinal obstruction, recal atresia (0.4%), NTDs (0.8%)
?PROM
How many women undergo plastic surgery following bariatric surgery?
12%
Advise to wait until after family complete
Which type of surgery has shown low plasma levels or the COCP?
Jejuno-ileal bypass surgery
How many women may require parenteral nutrition following biliopancreatic diversion?
21%
What are the antenatal considerations in management following surgery?
MDT Nutritional status and supplementation Weight every visit to monitor gestational weight gain Anaesthetic and paediatric alerts Fasting/2hr BMs at 26-28/40 Screen for NTDs and serial growth scans Consider diagnosis of intestinal obstruction when presenting with pain and vomiting Assess for LMWH
What is the mortality rate of bariatric surgery?
0.1-1.1% mortality
What long term weight loss can be achieved with bariatric surgery?
14-25%
