The impact of gastric bypass surgery on sex hormones and menstrual cycles in premenopausal women.

Obesity has adverse effects on ovulation, menstrual cyclicity and oocyte development leading to clinical symptoms such as infertility and menstrual disorders. The Roux-en-Y gastric bypass (RYGB) leads to weight loss, improved insulin sensitivity and may improve ovarian function. In 31 premenopausal women, 18 eu- and 13 oligo-/amenorrhoic, we followed the changes in follicular phase sex hormones 3, 6 and 12 month after RYGB. The average weight loss during the first postoperative year was 39.6 kg. The insulin sensitivity and serum insulin improved markedly especially within the first three postoperative months. SHBG increased progressively and was doubled after 12 months. In contrast, total and free androgens and DHEA declined about 50% during the first three postoperative months and remained fairly constant hereafter. One year after surgery, 85% (11/13) of the women with oligo-/amenorrhea gained regular menstrual cycles. Our results indicate that some of the endocrine changes related to regulation of ovarian function occur very early after bariatric surgery.

The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study.

OBJECTIVE: The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery. STUDY DESIGN: Nationwide register-based matched cohort study of singleton deliveries after bariatric surgery during 2004-2010. Data were extracted from The Danish National Patient Registry and The Medical Birth Register. Each woman with bariatric surgery (exposed) was individually matched with 4 women without bariatric surgery (unexposed) on body mass index, age, parity, and date of delivery. Continuous variables were analyzed with the paired t test and binary outcomes were analyzed by logistic regression. RESULTS: We identified 339 women with a singleton delivery after bariatric surgery (84.4% gastric bypass). They were matched to 1277 unexposed women. Infants in the exposed group had shorter mean gestational age (274 vs 278 days; P < .001), lower mean birthweight (3312 vs 3585 g; P < .001), lower risk of being large for gestational age (adjusted odds ratio, 0.31; 95% confidence interval, 0.15-0.65), and higher risk of being small for gestational age (SGA) (adjusted odds ratio, 2.29; 95% confidence interval, 1.32-3.96) compared with infants in the unexposed group. No statistically significant difference was found between the groups regarding the risk of gestational diabetes mellitus, preeclampsia, labor induction, cesarean section, postpartum hemorrhage, Apgar score less than 7, admission to neonatal intensive care unit or perinatal death. CONCLUSION: Infants born after maternal bariatric surgery have lower birthweight, lower gestational age, 3.3-times lower risk of large for gestational age, and 2.3-times higher risk of SGA than infants born by a matched group of women without bariatric surgery. The impact on SGA was even higher in the subgroup with gastric bypass.

Pregnancy after bariatric surgery--a review of benefits and risks.

BACKGROUND: When other weight loss attempts have failed, bariatric surgery offers a successful alternative for obesity. Since operations are performed during women's reproductive years, the number of pregnant women with prior bariatric surgery is increasing. Bariatric surgery results in restriction of food intake and/or malabsorption leading to weight loss, but may induce a risk for malnutrition and pregnancy complications. METHOD: Systematically conducted review addressing pregnancy after bariatric surgery using the PubMed and Cochrane databases. MAIN OUTCOME MEASURES: Birthweight, gestational age, birth defects, preeclampsia, gestational diabetes mellitus, and mode of delivery. RESULTS: We included 17 articles in English, comparing pregnancies in women with prior bariatric surgery to pregnancies in a control group without this. There was considerable heterogeneity in study design and six of the studies included <50 women with bariatric surgery. Eight studies described lower birthweight and lower risk of macrosomia after bariatric surgery, but in six there was no difference. Five studies indicated a higher risk of small-for-gestational age infants, but only compared with non-obese women or severely obese controls. There was no difference in gestational length. Only one study suggested a higher risk of birth defects after surgery. The maternal risk of preeclampsia and gestational diabetes mellitus was lower after bariatric surgery. Results regarding mode of delivery are conflicting. CONCLUSION: Pregnancy after bariatric surgery seems safe but larger studies matching or adjusting for body mass index are needed to improve the surveillance of these pregnancies and to assist in preventing adverse outcomes.

[Christmas article: Coitus is not recommended - a systematic review].

The overall positive effects of coitus have not been estimated before. A systematic review and meta-analysis was conducted for coitus versus everything. A search was made in MEDLINE resulting in 1,121 hits. The authors screened studies and conducted a meta-analysis. Thirty publications randomising to coitus or something else were included. Pooled results showed a relative risk of 0.91 (95% CI: 0.86-0.96) favouring "everything else" over coitus. Subjective pleasure is not a primary outcome in any of the included studies, and trialists must have regarded this outcome as less important. In conclusion, coitus cannot be recommended based on the published randomised studies. Evaluation by evidence-based methodology makes it clear, that better alternatives exist.

[Pregnancy after bariatric surgery].

This is a review of the recommendations regarding pregnancy after bariatric surgery from the Danish Society of Obstetrics and Gynaecology. The risk of vitamin/mineral deficiencies should be emphasized and checked with blood samples. Measurements of fetal growth should be offered at gestational age 28 and 34 as a supplement to the standard prenatal procedures because of the increased risk of intrauterine growth retardation. Because of persistent obesity there is still an increased risk of hypertension and diabetes mellitus. In case of abdominal pain internal herniation should be suspected.

Timing of pregnancy after gastric bypass-a national register-based cohort study.

BACKGROUND: Current recommendations suggest postponing pregnancy by at least 1 year after gastric bypass. During the first postoperative year, women are in a catabolic phase with a rapid weight loss which may increase the risk of adverse pregnancy and neonatal outcomes. This study tested the hypothesis that the risk of adverse pregnancy and neonatal outcomes is increased in women who conceive during the first year after gastric bypass surgery. METHODS: This is a national register-based cohort study covering all Danish deliveries during 2004-2010 in women with prior Roux-en-Y gastric bypass surgery. Only the first postoperative birth was included. The risk of adverse pregnancy and neonatal outcomes was compared between women who conceived within the first postoperative year and women who conceived later. Data were extracted from the Danish National Patient Registry and The Danish Medical Birth Register. RESULTS: Of 286 women who had a singleton delivery after Roux-en-Y gastric bypass surgery, 158 women conceived within the first year and 128 later. There was no statistically significant difference (p > 0.05) between the two groups regarding neonatal birth weight, gestational age, risk of preeclampsia, gestational diabetes mellitus, labor induction, cesarean section, postpartum hemorrhage (>500 ml), preterm birth (before 37 weeks), small for gestational age, large for gestational age, or Apgar score (5 min ) below 7, or in the need of neonatal intensive care. CONCLUSIONS: This study showed no evidence to support a recommendation to delay pregnancy until after the first postoperative year. At present, the optimal time for pregnancy after gastric bypass is unknown.

[Pregnancy following bariatric surgery requires special attention]. / Graviditet efter bariatrisk kirurgi kræver speciel opmærksomhed.

In the latest years the number of pregnant women having undergone bariatric surgery before pregnancy has increased rapidly. In pregnancy, they seem to have a reduced risk of obesity-related complications but an increased risk of mechanical complications causing small bowel obstruction and complications due to malabsorption. This article reviews the effect of bariatric surgery before pregnancy on obstetric and neonatal outcomes and provides, based on the limited available evidence, recommendations for the management of pregnancy in these women.