Intrauterine growth retardation after laparoscopic Roux-en-Y gastric bypass — clinical presentation and literature review

Abstract

Bariatric surgery is associated with a higher risk of intrauterine growth retardation (IUGR) and small for gestational age
neonates. We present two examples of IUGR after laparoscopic Roux-en-Y gastric bypass, both associated with excessive
restriction in patients caloric intake, one due to obstetrician’s indications and the other resulting from patient’s anxiety
of weight gain in pregnancy. IUGR was observed accordingly in the 35^th and 28^th week of pregnancy. The first patient
had an urgent cesarean section due to pathological cardiotocography tracings in the 35^th week of pregnancy, with the
newborn’s weight of 1690 g (< 1^st percentile). The second patient, admitted in the 28^th week with suspected IUGR, had
an elective cesarean section in the 36^th week, with the newborn’s weight of 2095 g (5^th percentile). Although malabsorptive
mechanisms are known to be involved in the impaired fetal growth after bariatric surgery, patients’ and obstetricians’
adherence to nutrition and supplementation regimen are of utmost importance. The problem of optimum daily caloric
intake, vitamin and micronutrients supplementation in pregnancies after bariatric surgery is presently discussed in the
literature. Optimum care and advice for bariatric patients have to be diversified as malabsorptive and restrictive operations
lead to changes in metabolism, nutrition and hormonal balance.