Abstract
Background
Little information exists to guide monitoring and treatment of malnourishment during
pregnancy after bariatric surgery. Here we present a case with severe deficiencies
and recommendations for testing and treatment.
Case
Our patient underwent a duodenal switch procedure resulting in significant weight
loss and numerous deficiencies. She then experienced a neonatal demise with multiple
congenital abnormalities, including diaphragmatic hernia, possibly related to severe
vitamin A deficiency. After high doses of oral and parenteral replacement, pancreatic
enzymes, and total parenteral nutrition, she delivered an anatomically normal but
growth-restricted neonate in a subsequent pregnancy.
Conclusion
Bariatric procedures may result in nutritional deficiencies that affect pregnancy
outcome. Women with severe deficiencies require pre-pregnancy counselling, monitoring,
aggressive treatment, and a multidisciplinary approach to care.
Résumé
Contexte
Il n'existe que peu de données pour guider le suivi et le traitement de la malnutrition
pendant la grossesse à la suite d'une chirurgie bariatrique. Nous présentons ici un
cas caractérisé par de graves carences nutritionnelles ainsi que des recommandations
aux fins de dépistage et de traitement.
Cas
Notre patiente a subi une permutation duodénale qui a entraîné une importante perte
de poids et de nombreuses carences nutritionnelles. Sa grossesse s'est soldée par
le décès du fœtus, qui présentait plusieurs anomalies congénitales, dont une hernie
diaphragmatique, possiblement attribuables à une grave carence en vitamine A. La patiente
a par la suite reçu de grandes doses de produits de remplacement par voies orale et
parentérale et d'enzymes pancréatiques, et a été alimentée par nutrition parentérale
totale avant de donner naissance à un bébé ne présentant aucune anomalie anatomique,
à l'exception d'un retard de croissance.
Conclusion
Les chirurgies bariatriques peuvent être à l'origine de carences nutritionnelles ayant
des effets défavorables sur l'issue de la grossesse. Avant de tomber enceintes, les
femmes présentant de graves carences ont besoin d'être conseillées, suivies et traitées
de façon intensive au moyen d'une approche de soins multidisciplinaire.
Key Words
Abbreviations:
BPD (biliopancreatic diversion), ACOG (American Congress of Obstetricians and Gynecologists), IUGR (intrauterine growth restriction), RCOG (Royal College of Obstetricians and Gynaecologists), LGA (large for gestational age), SGA (small for gestational age)To read this article in full you will need to make a payment
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References
- Pregnancy and fertility following bariatric surgery: a systematic review.JAMA. 2008; 300: 2286-2296
- Outcomes of pregnancy after bariatric surgery.N Engl J Med. 2015; 372: 2267-2268
- Malabsorption as a therapeutic approach in bariatric surgery.Viszeralmedizin. 2014; 30: 198-204
- Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study.BMJ. 2013; 347: f6460
- Use of home parenteral nutrition in post-bariatric surgery-related malnutrition.JPEN J Parenter Enteral Nutr. 2016; (pii: 0148607116649222)
- The duodenal switch operation for the treatment of morbid obesity.Ann Surg. 2003; 238 (discussion 627–8): 618-627
- Vitamin deficiency in pregnancy.Obstet Gynecol. 2013; : 434-436
- Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects.Nutr J. 2014; 13: 59
- Hypovitaminosis A in the sugarcane zone of southern Pernambuco State, Northeast Brazil.Am J Clin Nutr. 1972; 25: 800-804
- Etiology of congenital diaphragmatic hernia: the retinoid hypothesis.Pediatr Res. 2003; 53: 726-730
- Retinol status of newborn infants is associated with congenital diaphragmatic hernia.Pediatrics. 2010; 126: 712-720
- Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring.Birth Defects Res A Clin Mol Teratol. 2013; 97: 60-66
- The relationship between maternal vitamin D deficiency and low birth weight neonates.J Family Reprod Health. 2015; 9: 113-117
- Health characteristics and outcomes of two randomized vitamin D supplementation trials during pregnancy: a combined analysis.J Steroid Biochem Mol Biol. 2013; 136: 313-320
- Fetal cerebral hemorrhage caused by vitamin K deficiency after complicated bariatric surgery.Obstet Gynecol. 2008; 112: 434-436
- Vitamin K1 monitoring in pregnancies after bariatric surgery: a prospective cohort study.Surg Obes Relat Dis. 2014; 10: 885-890
- Practice bulletin no. 105: bariatric surgery and pregnancy.Obstet Gynecol. 2009; 113: 1405-1413
- Scientific impact paper No 17: the role of bariatric surgery in improving reproductive health.(Available at:)https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_17.pdf(Accessed December 6, 2016)Date: 2015
- Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study.PLoS ONE. 2014; 9: e114192
- Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis.Obes Surg. 2015; 26: 429-442
- Mineral malnutrition following bariatric surgery.Adv Nutr. 2013; 4: 506-517
Article info
Publication history
Published online: September 01, 2017
Accepted:
June 9,
2017
Received:
March 11,
2017
Footnotes
Competing interests: None declared.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
