Gastric bypass is one the most commonly performed weight reduction surgeries in the world. The obesity rate is growing dramatically. Obesity is characterized by a state of hyperinsulinism, hyperandrogenism, dyslipidaemia, hypertension and polycystic ovary syndrome, leading to amenorrhoea and infertility.
Weight loss can change the mechanism of fertility. Women who suffer from morbid obesity are often infertile. Even if an obese woman is able to get pregnant, it is still considered as high risk because of the obesity complications for the baby such as macrosomia, preeclampsia, miscarriage, gestational diabetes, pregnancy-induced hypertension, labour induction, Caesarean section, birth defects, post-partum weight retention, juvenile obesity and other associated risks.
Gastric bypass surgery is a type of bariatric weight loss surgery that makes the stomach smaller and allows food to bypass parts of the digestive system, thus reducing the amount of calories a person absorbs and restricting the amount of calories a person can consume. This means that a patient eats less because he or she feels full quickly and some of the food will not be fully digested. Gastric surgery helps to fight obesity.
Roughly half of all gastric bypass surgery patients are women of reproductive age. Gastric bypass surgery is the safest and the most effective method of weight loss for obese women of childbearing age, with preferential outcomes for pregnancies after surgery.
Large numbers of women in their reproductive age may undergo bariatric surgery, which may change fertility following weight loss. Pregnancy after bariatric surgery is not only safe for mother and baby but may also be less risky and might protect obese women and their babies from obesity-related problems and complications during and after pregnancy. Babies born to women who had gastric bypass surgery have just as much of a chance at being perfectly healthy as babies born to other women. Patients understanding the mechanism of weight loss surgery can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population and it is key for as successful surgery outcome.
Complications specific to gastric bypass surgery may include hyperemesis, bleeding from gastrointestinal tract or wound, anastomotic leak, gastric perforation, nutritional deficiencies, anastomotic stricture, internal hernia, wound infection, heart attack and others.
However, this intervention involves certain changes in the digestive process and physiology and is the source of nutritional and metabolic complications. People who have undergone gastric bypass surgery often have nutritional deficiencies in getting enough folic acid, thiamine, calcium, zinc, vitamin B12, vitamin D, vitamin A and iron.
Mothers who have undergone gastric bypass surgery having lack of nutrition can become a serious problem to babies growing in their womb. Gastric bypass surgery may potentially lead to fetal complications, including preterm birth, low birth weight, fetal mental retardation, neonatal hypocalcemia or rickets, maternal osteomalacia, and neural tube defects.
Anemia can be secondary to iron deficiency, folic acid deficiency and even to vitamin B12 deficiency. Neurological disorders such as Gayet-Wernicke encephalopathy due to thiamine deficiency, or peripheral neuropathies may also be observed.
Complications such as bone demineralization due to vitamin D and calcium deficiency, hair loss secondary to zinc deficiency or hemeralopia from vitamin A deficiency may occur.
After gastric surgery it is recommended to wait approximately 12-18 months before becoming pregnant until the woman’s weight stabilizes. This delay helps to avoid most of the potential nutritional complications for a pregnant woman and her baby.
Preoperative assessment and selection should be performed by a multidisciplinary team to obtain optimal results after surgery. The nutritional status of the woman after gastric bypass surgery and during her pregnancy should be closely monitored. Weight changes during pregnancy during the postpartum period should be followed in an effort to maximize weight loss and ensure fetal health. Prenatal care is best accomplished with careful coordination between the obstetrician and the bariatric surgeon.