open access

Vol 92, No 3 (2021)
Review paper
Published online: 2021-02-10
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Intrauterine growth retardation after laparoscopic Roux-en-Y gastric bypass — clinical presentation and literature review

Anna Rozanska-Waledziak1, Joanna Kacperczyk-Bartnik1, Maciej Waledziak2, Pawel Bartnik1, Andrzej Kwiatkowski2, Justyna Teliga-Czajkowska1, Krzysztof Czajkowski1
·
Pubmed: 33576472
·
Ginekol Pol 2021;92(3):226-229.
Affiliations
  1. 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
  2. Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland

open access

Vol 92, No 3 (2021)
REVIEW PAPERS Obstetrics
Published online: 2021-02-10

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 35th and 28th week of pregnancy. The first patient
had an urgent cesarean section due to pathological cardiotocography tracings in the 35th week of pregnancy, with the
newborn’s weight of 1690 g (< 1st percentile). The second patient, admitted in the 28th week with suspected IUGR, had
an elective cesarean section in the 36th week, with the newborn’s weight of 2095 g (5th 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.

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 35th and 28th week of pregnancy. The first patient
had an urgent cesarean section due to pathological cardiotocography tracings in the 35th week of pregnancy, with the
newborn’s weight of 1690 g (< 1st percentile). The second patient, admitted in the 28th week with suspected IUGR, had
an elective cesarean section in the 36th week, with the newborn’s weight of 2095 g (5th 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.

Get Citation

Keywords

bariatric surgery; fetal growth retardation; avitaminosis

About this article
Title

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

Journal

Ginekologia Polska

Issue

Vol 92, No 3 (2021)

Article type

Review paper

Pages

226-229

Published online

2021-02-10

Page views

739

Article views/downloads

828

DOI

10.5603/GP.a2020.0163

Pubmed

33576472

Bibliographic record

Ginekol Pol 2021;92(3):226-229.

Keywords

bariatric surgery
fetal growth retardation
avitaminosis

Authors

Anna Rozanska-Waledziak
Joanna Kacperczyk-Bartnik
Maciej Waledziak
Pawel Bartnik
Andrzej Kwiatkowski
Justyna Teliga-Czajkowska
Krzysztof Czajkowski

References (15)
  1. Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013. Obes Surg. 2015; 25(10): 1822–1832.
  2. Walędziak M, Różańska-Walędziak AM, Kowalewski PK, et al. Present trends in bariatric surgery in Poland. Wideochir Inne Tech Maloinwazyjne. 2019; 14(1): 86–89.
  3. Shawe J, Ceulemans D, Akhter Z, et al. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care. Obes Rev. 2019; 20(11): 1507–1522.
  4. Galazis N, Docheva N, Simillis C, et al. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014; 181: 45–53.
  5. Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018; 218(6): 573–580.
  6. Akhter Z, Rankin J, Ceulemans D, et al. Pregnancy after bariatric surgery and adverse perinatal outcomes: A systematic review and meta-analysis. PLoS Med. 2019; 16(8): e1002866.
  7. Chevrot A, Kayem G, Coupaye M, et al. Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol. 2016; 214(5): 655.e1–655.e7.
  8. Facchiano E, Iannelli A, Santulli P, et al. Pregnancy after laparoscopic bariatric surgery: comparative study of adjustable gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012; 8(4): 429–433.
  9. Sheiner E, Levy A, Silverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol. 2004; 190(5): 1335–1340.
  10. Johansson K, Cnattingius S, Näslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015; 372(9): 814–824.
  11. Kjær MM, Lauenborg J, Breum BM, et al. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013; 208(6): 464.e1–464.e5.
  12. Belcastro MR, Neiger R, Ventolini G. Intrauterine growth restriction after bariatric surgery. Journal of Neonatal-Perinatal Medicine. 2011; 4(3): 231–234.
  13. Aricha-Tamir B, Weintraub AY, Levi I, et al. Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery. Surg Obes Relat Dis. 2012; 8(4): 434–439.
  14. Coupaye M, Legardeur H, Sami O, et al. Impact of Roux-en-Y gastric bypass and sleeve gastrectomy on fetal growth and relationship with maternal nutritional status. Surg Obes Relat Dis. 2018; 14(10): 1488–1494.
  15. Rottenstreich A, Elchalal U, Kleinstern G, et al. Maternal and Perinatal Outcomes After Laparoscopic Sleeve Gastrectomy. Obstet Gynecol. 2018; 131(3): 451–456.

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