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The following links are questions Dr. Callery has answered answered on Thinner Times Forum - Forums for gastric bypass, Lap Band, and Vertical Sleeve Gastrectomy:

The following abstracts are offered from the recent medical literature. To search: PubMed.

Pregnancy following gastric bypass surgery for morbid obesity.

Gurewitsch ED, Smith-Levitin M, Mack J

Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, New York, USA.

BACKGROUND: Surgical treatment for severe obesity is sometimes recommended. Many long-term risks, particularly to adolescents and to subsequent pregnancies, are still being determined. CASE: A 23-year-old woman, gravida 6, para 2, treated for morbid obesity during adolescence with gastric bypass surgery, presented at 6 weeks' gestation with severe microcytic anemia. Significant iron and cobalamin deficiencies were found. Although the vitamin B12 deficiency responded to parenteral treatment, the iron deficiency was refractory to oral supplementation because of malabsorption. By 30 weeks' gestation, the patient required blood transfusions to correct the progressive anemia. Subsequently, she delivered a healthy male infant at term. CONCLUSION: Severe iron deficiency anemia resulting from malabsorption can complicate pregnancy following gastric bypass surgery for morbid obesity. For women of childbearing age, this potential adverse effect must be considered.

Obstet Gynecol 1996 Oct;88(4 Pt 2):658-61

Pregnancy following gastric bypass for morbid obesity.

Wittgrove AC, Jester L, Wittgrove P, Clark GW

Department of Surgery, Alvarado Hospital and Medical Center, San Diego, CA, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

BACKGROUND: Women who suffer from morbid obesity are often infertile. If these women are able to become pregnant, they are considered high risk because of the hypertension, diabetes and other associated risk factors. Following the pregnancy is difficult due to limitations of the physical examinations. More costly ultrasound examinations are needed at a higher frequency. Bariatric surgery reduces the woman's weight and the incidence of obesity related co-morbidities. The number of pregnancies and rate of complications during those pregnancies in our post-bariatirc surgical patients were evaluated. METHOD: Our group has been doing bariatric surgery since the early 1980s. We have over 2000 active patients on our current newsletter mailing list. The patients also have a series of networks through support groups. The patients are informed to contact us when they become pregnant so we may assist the obstetrician with their care. Through these various means, we have been able to identify 41 women in our patient population who have become pregnant. Using personal interview, questionnaire, and review of perinatal records, pregnancy-related risks and complications were studied. RESULTS: With over a 95% follow-up rate on the patients identified as having been pregnant following surgery, we found less risk of gestational diabetes, macrosomia, and cesarean section than associated with obesity. There were no patients with clinically significant anemia. CONCLUSION: Since the patients had an operation that restricts their food intake, some basic precautions should be taken when they become pregnant. With this in mind, our patients have done well with their pregnancies. The post-surgical group had fewer pregnancy-related complications than did an internally controlled group that were morbidly obese during their previous pregnancies.

Obes Surg 1998 Aug;8(4):461-4; discussion 465-6

Pregnancy after gastric bypass for morbid obesity.

Richards DS, Miller DK, Goodman GN

There has been only one previous report on pregnancies following gastric bypass for the treatment of morbid obesity. In this study 57 such pregnancies were compared to a group of control pregnancies occurring in morbidly obese women before their bypass surgery. There was a significantly lower incidence of hypertension and large-for-gestational-age infants in the postoperative pregnancies. There was no significant difference in a number of other pregnancy complications studied.

J Reprod Med 1987 Mar;32(3):172-6

Pregnancy following gastric bypass for the treatment of morbid obesity.

Printen KJ, Scott D

Of the patients undergoing gastric bypass for treatment of morbid obesity, 75 per cent are female. A common question both pre-and postoperatively concerns the advisability of a pregnancy following surgically-induced weight loss. Of all patients, 45 became pregnant on 54 occasions following gastric bypass and 46 infants were delivered. There were two spontaneous abortions (4.0%) and six early terminations of an undesired pregnancy. Seven infants were delivered prematurely. One child was born microcephalic and has developed severe retardation in both growth and development. In contrast to reports of infants born to mothers with jejunoileal bypass, 12 of the babies that were born to mothers after gastric bypass were heavier at birth than older siblings. An additional ten infants were the first born to women who had lost more than 100 pounds following gastric bypass. All but one of the women became pregnant more than six months following surgery. This corresponds to the period of maximum weight loss and reversal of menstrual abnormalities associated with massive obesity. Pregnancies were well tolerated by the mothers, with no excessive increase in weight loss or development of metabolic deficiencies. Since the gastric bypass is modeled on the Billroth II gastrectomy, additional iron supplementation was recommended during the pregnancy. While we cannot recommend pregnancy during the period of rapid weight loss in the initial postoperative period, our data indicate that neither the mother nor the developing fetus is unduly endangered by a pregnancy which develops after the period of rapid postoperative weight loss.

Am Surg 1982 Aug;48(8):363-5

Pregnancy outcome and weight gain recommendations for the morbidly obese woman.

Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ

Department of Obstetrics and Gynecology, The Mount Sinai Medical Center, New York, New York, USA.

OBJECTIVE: To compare pregnancy outcomes between morbidly obese and nonobese women and to determine the effect of gestational weight gain on pregnancy outcome in morbidly obese women. METHODS: A retrospective cohort study was conducted comparing 613 morbidly obese and 11,313 nonobese women who were delivered of a singleton live birth. Morbid obesity was defined as a body mass index greater than 35. The incidence of selected perinatal and neonatal outcomes was assessed for the two groups. Multiple logistic regression analysis was used to evaluate the association between morbid obesity and various measures of outcome while controlling for potential confounders. A subanalysis of the morbidly obese patients was performed to assess the effect of gestational weight gain on pregnancy outcome. RESULTS: Morbidly obese patients were more likely to experience pregnancy complications including diabetes, hypertension, preeclampsia, and arrest-of-labor disorders; however, these were not affected by gestational weight gain. Morbidly obese patients were more likely to experience fetal distress and meconium and to undergo cesarean delivery than their nonobese counterparts (P < .05). Weight gains of more than 25 lb were associated strongly with birth of a large for gestational age (LGA) neonate (P < .01); however, poor weight gain did not appear to increase the risk of delivery of a low birth weight neonate. CONCLUSION: Gestational weight gain was not associated with adverse perinatal outcome, but it did influence neonatal outcome. To reduce the risk of delivery of an LGA newborn, the optimal gestational weight gain for morbidly obese women should not exceed 25 lb.

Obstet Gynecol 1998 Jan;91(1):97-102

Perinatal outcome in pregnancy complicated by massive obesity.

Perlow JH, Morgan MA, Montgomery D, Towers CV, Porto M

Department of Obstetrics and Gynecology, Long Beach Memorial Medical Center Women's Hospital, California.

OBJECTIVE: Our objective was to determine the impact of massive obesity during pregnancy, defined as maternal weight > 300 pounds, on perinatal outcome. STUDY DESIGN: A case-controlled study was conducted. Between Jan. 1, 1986, and Dec. 31, 1990, 111 pregnant women weighing > 300 pounds who were delivered at Long Beach Memorial Women's Hospital were identified with a perinatal data base search. A control group matched for maternal age and parity was selected, and perinatal variables were compared between groups. To control for potential confounding medical complications, massively obese patients with diabetes and/or chronic hypertension antedating the index pregnancy were excluded from the obese group, and the data were reanalyzed. The Student t test chi 2, and Fisher's exact statistical analysis were used where appropriate. RESULTS: Massively obese pregnant women are significantly more likely to have a multitude of adverse perinatal outcomes, including primary cesarean section (32.4% vs 14.3%, p = 0.002), macrosomia (30.2% vs 11.6%, p = 0.0001), intrauterine growth retardation (8.1% vs 0.9%, p = 0.03), and neonatal admission to the intensive care unit (15.6% vs 4.5%, p = 0.01). They also are significantly more likely to have chronic hypertension (27.0% vs 0.9%, p < 0.0001) and insulin-dependent diabetes mellitus (19.8% vs 2.7%, p = 0.0001). However, when those massively obese pregnant women with diabetes and/or hypertension antedating pregnancy are excluded from analysis, no statistically significant differences in perinatal outcome persisted. CONCLUSION: Massively obese pregnant women are at high risk for adverse perinatal outcome; however, this risk appears to be related to medical complications of obesity.

Am J Obstet Gynecol 1992 Oct;167(4 Pt 1):958-62

Pregnancy outcomes after gastric-bypass surgery.

Dao T, Kuhn J, Ehmer D, Fisher T, McCarty T.

Baylor University Medical Center, 3409 Worth Street, Suite 420, Dallas, TX 75246, USA.

BACKGROUND: The purpose of this study is to compare outcomes of patients who become pregnant within the first year after surgery and those who delayed pregnancy until after 1 year after surgery. METHODS: A retrospective review was performed to identify patients who became pregnant after their gastric-bypass surgery from 2001 to 2004. Endpoints included pregnancy complications, fetal birth weight and outcome, delivery method, weight change during pregnancy, and nutrition. RESULTS: Of 2,423 patients who had undergone bariatric surgery from 2001 to 2004, 21 patients became pregnant within the first year after surgery and 13 became pregnant after 1 year. Similar outcomes were seen between the 2 groups regarding fetal weight, term pregnancy, and complications. CONCLUSIONS: Pregnancy outcomes within the first year after weight-loss surgery revealed no significant episodes of malnutrition, adverse fetal outcomes, or pregnancy complications. Anxiety over poor outcomes of pregnancy during the first year after bariatric surgery can be allayed..

Am J Surg. 2006 Dec;192(6):762-6.



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