Considerations for Bariatric Surgery

Given the growing number of women with severe obesity, it is not surprising that the number of women who are seeking extreme measures to lose weight, e.g., bariatric surgery, is increasing. As discussed in detail in Chap. 6 ("Pregnancy and Weight Loss Surgery"), surgical interventions to lose weight, unless expertly planned, are not without potential consequences for mother and infant. In addition to promoting weight loss, malabsorptive type surgeries such as gastric bypass have resulted in suboptimal maternal absorption of calcium, iron, folic acid, and vitamin B12 [69]. While these surgeries have had a positive impact on reducing maternal risk for GDM and hypertensive disorders, case reports of intrauterine growth restriction, premature birth, and NTDs have been described [70]. Because of these limitations, the laparoscopic adjustable gastric banding procedure is being used more frequently as a means of restricting stomach volume, decreasing intake, and promoting weight loss [71]. The adjustability of banding also allows for adaptations to altered requirements of pregnancy. Early reports on follow-up of pregnant women who have had this type of procedure are encouraging and indicate reduced risk of malabsorption, GDM, gestational hypertension, and preterm deliveries [71]. To ensure optimal pregnancy outcome and minimize maternal and fetal risks, the American College of Obstetricians and Gynecologists recommends that women delay pregnancy for 12-18 months after surgery to avoid pregnancy during the rapid weight loss phase [67]. Vitamin supplementation is also advised if nutritional deficiencies occur.

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