Pregnancy After Bariatric Surgery: A Narrative Review of Nutritional Surveillance and Fetal Growth
DOI:
https://doi.org/10.5281/zenodo.22260611Keywords:
Bariatric surgery, Pregnancy, Small for gestational age, Micronutrient deficiency, Nutritional surveillanceAbstract
Bariatric surgery before pregnancy does not make pregnancy safer in a simple sense; it exchanges one set of risks for another.
Rates of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia and large-for-gestational-age birth fall, while
small-for-gestational-age birth, preterm delivery and micronutrient deficiency rise. Meta-analysis of observational studies reports
that infants born after bariatric surgery weigh a mean of 242 g less than those born to women without prior surgery (95% CI -307
to -177, p < 0.001). The most uncomfortable finding concerns surveillance. In a cohort of 57 pregnancies in 48 women,
small-for-gestational-age neonates occurred in 36.0 per cent, and although supplement uptake rose from 56.8 per cent before
conception to 100 per cent in the third trimester, third-trimester deficiency was still present for vitamin C in 83.3 per cent,
selenium in 50.0 per cent and vitamin A in 40.0 per cent. Supplementation as delivered did not prevent deficiency. This review sets
out what is measured, what is recommended and where the two diverge.
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