Gastric Bypass and Pregnancy : Which One is More Difficult ?

There are some well known risks for the patient and the baby after obesity surgery, but it should be indicated that, prognancy at the obese women is quite risky whether obesity surgery procedures have not been applied. In developed countries, obesity is one of the most clearest nutrition problem that endanger the pregnancy. Prepregnancy obesity is a risk that increases the posibility of encountering with many negativities can be faced at the pregnancy. Prepregnancy high weights increase infanth death during pragnancy as the studies recently executed.

In a study executed by Wittgrove et al. (Pregnancy Following Gastric Bypass for Morbid Obesity, Wittgrove et. al., Obesity Surgery, 8, 1998, 461-464) complication rates at the pregnancy have been interpreted with a definit number of pregnants. It has been recorded that from the followed patients those have experienced pregnancy after the operation, have 95% less risk for diabetes depending on pregnancy, macrosomia and caesarean. In conclusion, the patients which have underwent food intake avoiding operation are indicated to must take simple precautions during the pregnancy. The group those experienced pregnancy post operation had been exposed to less complications than the patients at the group of morbid obese at their previous pregnancy.

In a study recently executed by Patel et al. (Patel JA et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008 Jan-Feb;4(1):39-45.) and evaluates the pregnancy outcomes after gastric bypass application it has been showed that; there are similar risks to non obese women. In this study the author has indicated that pregnancy after gastric bypass application is safe and the complications will be occured are less from the obes women have not underwent operation and morbid obese pregnant women.

In the same way Wax JR et al. (Obesisty Surgery 2008) and Dao T et al. (American Journal of Surgery 2006) in their study have stated that there is not increasing in clear malnutrition episodes and bad fetal outcomes at the pregnancy outcomes after gastric bypass operation. Obtained results are similar to pregnancy of normal weight women.

Suggestions to the Patients Those Consider Pregnancy After Gastric Bypass Operation

The thing should be known is that there is risk both for mother and baby after the obesity surgery. Most of these risks are malnutrition and can be prevented by simple vitamin and mineral support. Preterm birth should be considered at pregnancy and up to this care and nutrition evaluations should be made. It is quite important to make the nutrition evaluation at the beginning of pregnancy. Laboratory data should be used and set up from stratch if there is a lack. Ideally best approach is to consider the nutrition problems at the pregnancy planning. Vitamin and iron support is important at all of the pregnancies but this is more important at the patients after gastric bypass operation. Prenatal vitamins, should be given not instead of the patient’s prescribed vitamin support, but in addition to this. Prepregnancy care should be followed up with careful coordination of the obesity surgeon and the gynaecologist.

Assoc. Prof. Halil Coskun M.D. www.halilcoskun.com

Evaluation of the Pregnancy and Birth Outcomes after Gastric Banding Surgery

Prevalence of the obesity that has been increased at recent years present the gynaecologists with obese pregnant women’s problems. At the women’s pregnancy period, obesity causes to increasing of some risks both for the mother and the baby will new born. The most important birth problems for the mother are premature birth risk, increased problems at the moment of birth, hypertension induced by pregnancy and preeclampsia, pregnancy diabetes and excess weight gaining during the pregnancy. On the other side intrauterin growth retardation, macrosomia and fetal growth anomalies are more frequently encountered for the baby.

Here, I will try to examine the outcomes of gastric banding (staple) surgery which we have encountered as a frequently used method at obesity treatment, on pregnant obese women.

Bar-Zohar et al. (Pregnancy after laparoscopic adjustable gastric banding: perinatal outcome is favorable also for women with relatively high gastational weight gain. Surg Endosc. 2006;20:1580-3) have evaluated 74 women those have become pregnant after gastric banding surgery and defined mean gained weight as 10.6±2.1 kg in their study. All births have realized after the 39_th week and mean birth weight has been identified as 3.09±0.5 kg. Major congenital anomaly at women, post-natal hypoglycemia at babies, baby death during or after the birth have not seen. In the light of these findings the authors those have performed this study, have been stated that; pregnancy and birth after gastric banding surgery are considerable confidential both for the mother and the baby.

John D. Dixon et al. (Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005;106:965-72) have indicated that pregnancy and birth outcomes of the women those have underwent gastric banding surgery are in compliance with values of the women those have become pregant with normal weight and as a result they have pointed out the reliability of this method on pregnant obese women. Adjustability of the staple is an important feature, because this provides the ability for adaptation of the surgery procedure as per pregnancy requirements. A multidisciplinary approach included collective collaboration of obesity surgeon and gynaecologist has been suggested after such applications.

Vejux N et al. (Pregnancy after gastric banding: maternal tolerance, obstetrical and neonatal outcomes. Gynecol Obstet Fertil 2007;35:1143-7) have made evaluation by studying on 7 papers concerning this issue. With regard to obtained data they have ben stated that gastric banding surgery is quite tolerated during the pregnancy and it could be suggested to the obese women in the age of birth child.

The studies mentioned above have showed the pregnancy problems depends on obesity may result in quite high danger. The weight loss after gastric banding which has been commonly used at recent years decrease these risks. The women those have underwent gastric banding operation and then become pregnant can complete their pregnancy process in a successful way without removed their staples and in company with the regular controls.

Assoc. Prof. Halil Coskun M.D.