Bariatric surgery and pregnancy

Obesity affects about 40% of reproductive age d females with a BMI of 30 or greater in the US, with the rising prevalence.

Obesity in pregnancy is associated with increased risk of almost all pregnancy complications, including: gestational diabetes, hypertensive disorders, small for gestational age or large for gestational age neonates, congenital anomalies, and cesarean delivery. 

Obesity changes, developmental programming in utero, contributing to increasing rates of childhood obesity, and related comorbidities later in life. 

The occurrence of bariatric surgery in reproductive age females with a BMI greater than or equal to 40 or BMI of 35 or greater with comorbidities such as diabetes or hypertension is increasing. 

Bariatric surgery before pregnancy is associated with reduce risk of gestational diabetes, large for gestational age, hypertensive disorders, postpartum hemorrhage, and cesarean delivery compared with BMI matched controls who did not undergo bariatric surgery.

Pregnancy after bariatric surgery is generally associated with improved outcomes, however, there are associated changes in anatomy, physiology, and nutrition with bariatric surgery that may be associated with anemia, micronutrient, deficiencies, congenital anomalies, preterm birth, delivery of small for gestational age, neonate, perinatal mortality, and maternal deaths in exceptional cases. 

Delaying conception for 12 to 24 months after bariatric surgery is recommended to allow for weight stabilization: due to rapid weight loss, pregnancy within the first year after bariatric surgery may be associated with higher rates of preterm delivery, delivery of a small for gestational, age neonate, and neonatal intensive care unit admission compared with pregnancies more than two years after bariatric surgery. 

Higher rates of oral contraceptive failure occur after bariatric surgery due to malabsorption medications and non-oral contraceptive methods, are encouraged. 

Pregnant persons who underwent bariatric surgery, are at increased risk of several macro and micronutrient deficiencies: iron, folate, calcium, and vitamin B 12. 

Diets that include the in protein, unsaturated fats, fruits, vegetables, and low glycemic index carbohydrates consumed in small, frequent portions are recommended. 

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