Main types
1) Sleeve gastrectomy
2) Roux-en-Y gastric bypass
3) Adjustable gastric band
Pregnancy planning/prevention
- Bariatric surgery improves fertility success rates, PCOS management. Compared with controls, there are lower rates of miscarriage, gestational diabetes, hypertension, fetal macrosomia, and congenital abnormalities.
- Wait until weight is stable (1 year after sleeve or Roux-en-Y, 2 years gastric band)
- Avoid oral contraceptives (use LARC)
- Test for diabetes before pregnancy
- Optimise weight, nutritional status and diabetes >3 months before pregnancy
Risks
- Malnutrition
- Fetal growth restriction
- Worsening postprandial (“dumping”) syndromes
- Postoperative intra-abdominal complications
Preventing/treating malnutrition
- Vitamin D 1000 units OD
- Folic acid (400 mcg OD if not obese, 5 mg OD if obese)
- Monitor weight gain & intervene if poor
Check in each trimester:
- FBC, folate, ferritin, B12, iron studies
- U&Es
- LFTs
- Vitamin D, calcium, phospate, PTH
- Magnesium
- Vitamin A
- PT, INT (vitamin K if abnormal clotting)
- Vitamin E, zinc, copper, selenium (first trimester only)
Fetal surveillance
- Growth in the third trimester
Breastfeeding
- Encourage – continue nutritional supplements (and monitoring if abnormal)
Diabetes screening
- Test for GDM in all women
- Can use OGTT for gastric bands
- 1 week of BG monitoring (finger prick or continuous) for sleeve gastrectomy or Roux-en-Y (using >5.3 fasting or 7.8 at one hour)
Surgical complications
- Can occur during pregnancy (slippage, obstruction)
- Abdominal pain with a Roux-en-Y is obstruction until proven otherwise
Useful notes (O&G, MFM) 