Pregnancy after gastric bypass can be safe and healthy if managed well by you and your health care provider. In fact, research suggests that pregnancy after weight-loss surgery might be safer for both mother and baby than pregnancy complicated by obesity.
Currently, bariatric surgery is the most effective treatment available to treat morbid obesity. Women that are of childbearing age are a unique portion of the bariatric patient population.
A mother’s health conditions during pregnancy have a significant impact on the in utero environment, fetal development and the health of a child. As worldwide obesity rates rise, the health consequences affect an important subset of individuals, women of childbearing age. The prevalence of maternal obesity, defined as body mass index (BMI) of 30kg/m2 or more, has increased in the last few years and has become one of the most common health risk factors seen in obstetric practice.
Research shows that obesity is associated with infertility and, in those that are able to achieve pregnancy, an increased risk of gestational diabetes mellitus (GDM), gestational hypertension, and pre-eclampsia. Obesity has also been associated with an increased risk of spontaneous abortions, premature labor, cesarean section, and death. Parturients with obesity are also more likely to experience thrombosis episodes, as well as postpartum bleeding.
Maternal obesity has been associated with conditions related to abnormal fetal growth, including macrosomia.
Bariatric surgery is currently the best treatment option available for morbid obesity. Weight loss in women with obesity-related impaired fertility is associated with improved metabolic status, which makes pregnancy more probable. In these cases, the lost weight not only improves fertility, but it also reduces the risk of obstetric complications and becomes of an enormous benefit for the health of the mother and the child. Given that the number of post BS pregnancies is rising, the follow-up of these pregnancies has become a clinical, nutritional and obstetric challenge.
Post RYGB variable of T2DM remission was defined Partial remission is hemoglobin A1C (HbA1c) lower than 6.5% and fasting glucose between 100 and 125mg/dl. for one year and in absence of active pharmacological therapy or ongoing procedures. Complete remission is a return to “normal” measures of glucose metabolism (A1C in the normal range, fasting glucose <100 mg/dl [5.6 mmol/l]) for one year and in absence of active pharmacologic therapy or ongoing procedures Prolonged remission is defined as complete remission that lasts more than five years.
The time between the surgical intervention and the beginning of the pregnancy was documented. Other variables included the following: BMI at the beginning of pregnancy, weight gain during pregnancy (kg), term week calculated by date of last menstrual period (LMP) and ultrasound, weight of the newborn (kg), macrosomia (newborns of more than 4kg of weight), vaginal delivery or cesarean section, and fetal deaths.
RYGB produces an alteration in intestinal transit and absorption,Moreover, there are reports in the literature about reactive hypoglycemia and dumping during the oral tolerance glucose test performed after a RYGB. A cut off plasma glucose value of 100mg/dl or higher was considered for diagnosis.
A catastrophic complication of a Roux-en-Y gastric bypass is intestinal infarction resulting from herniation through an anatomical defect created during the procedure. This has been estimated to occur in up to 2 percent of patients. Symptoms and signs of internal herniation can be subtle and nonspecific; the diagnosis is often established only after frank intestinal infarction or at laparotomy. The increased abdominal pressure and cephalad intestinal displacement associated with the enlarging gravid uterus may contribute to the pathogenesis of intestinal herniation.
Potential complications of the procedure should be routinely considered in pregnant and nonpregnant patients who have had this surgery and present with abdominal pain. Computed tomographic (CT) scanning poses a minimal risk to a fetus5 and is recommended in these patients. Because CT is relatively insensitive for detecting internal herniation, however, exploratory laparotomy should be considered in appropriate clinical circumstances.