Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study.

BACKGROUND: Maternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy. METHODS: In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5). RESULTS: The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030). CONCLUSION: Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.

Uterine rupture in a nulliparous woman. / Uterusruptur hos førstegangsfødende.

BACKGROUND: Previous caesarean section is considered the main risk factor for uterine rupture. However, other surgical procedures performed on the uterus can also lead to rupture in future pregnancies. CASE PRESENTATION: The patient was a nulliparous woman, induced at gestational age of 41 + 6 with misoprostol. She developed severe persistent abdominal pain. Due to fetal bradycardia, an acute caesarean section was performed. Peroperatively a large rupture was identified in the uterine fundus and the placenta was detached into the abdomen. Medical history included a previous rightsided salpingectomy due to an extrauterine pregnancy located in the interstitial part of the right Fallopian tube. INTERPRETATION: Interstitial extrauterine pregnancy is rare, and recommendations for mode of delivery for subsequent pregnancies remain unclear. The current case illustrates the importance of being aware of the risk of rupture when the patient has undergone previous gynaecological surgery other than caesarean section, and of ensuring awareness of the placenta's location.

Temporal changes in fetal death risk in pregnancies with preeclampsia: Does offspring birthweight matter? A population study.

OBJECTIVES: To study the associations of preeclampsia with fetal death risk within percentiles of offspring birthweight, and whether these associations have changed during 1967-2014. STUDY DESIGN: In this population study, we included all singleton pregnancies in the Medical Birth Registry of Norway during 1967-2014 (n = 2 607 199). Odds ratios (ORs) for fetal death associated with preeclampsia were estimated within percentiles of birthweight by applying logistic regression analyses. We estimated ORs for the study period as a whole, and for the years 1967-1983 and 1984-2014. RESULTS: During the study period as a whole, preeclampsia increased the risk of fetal death, OR 2.73 (95% CI 2.57-2.89), and the fetal death risk associated with preeclampsia differed across percentiles of offspring birthweight. The overall risk of fetal death decreased during our study period, and the decrease was most prominent in preeclamptic pregnancies with low offspring birthweight (<1 percentile). Thus, in recent years, the risk of fetal death in pregnancies with low offspring birthweight was lower in preeclamptic than in non-preeclamptic pregnancies, OR 0.22 (95% CI 0.12-0.41). Only in pregnancies with offspring birthweight within the 10-90 percentiles, the risk of fetal death associated with preeclampsia remained significantly increased throughout the study period. CONCLUSIONS: The decline in fetal death risk was most prominent in preeclamptic pregnancies with low offspring birthweight. The introduction of a national screening program for preeclampsia in the 1980s, and identification of growth restricted offspring by fetal ultrasonography, may explain our findings.

Use of contraception among women who request first trimester pregnancy termination in Norway.

OBJECTIVES: Among women requesting pregnancy termination, we studied the proportion of women who reported having used contraception when they became pregnant and the contraceptive method that they had used. STUDY DESIGN: We included all requests for pregnancy termination in Norway during the years 2007-2011 (n=80,346) by obtaining information from the Norwegian Registry of Pregnancy Termination. By using a logistic regression model, we estimated odds ratios for using any contraceptive method associated with the woman's age, previous childbirth, previous pregnancy termination, marital status, employment status and educational level. RESULTS: In total, 36.5% of the women who requested pregnancy termination (29,305/80,346) reported having used contraception when they became pregnant. Of all women, 16.6% reported having used the combined contraceptive pill/progestin pill, 11.5% the condom and 1.1% long-acting reversible contraceptives (1.0% intrauterine contraception). Overall, 38.9% of women 20-24years old had used contraception, compared to 29.9% of women 40-44years old (odds ratio 0.55, 95% confidence interval 0.51-0.60). Previous childbirth, previous pregnancy termination and high educational level were also associated with contraceptive use. CONCLUSION: Among women who requested pregnancy termination in Norway, 36.5% reported having used contraception when they became pregnant. Contraception use was associated with young age and having previously been pregnant. IMPLICATIONS: A large proportion of women who request pregnancy termination have experienced contraceptive failure. Women who are fertile and do not wish to become pregnant should be offered a contraceptive method that carries low risk of incorrect use.