Pregnancy nutritional indices and birth weight after Roux-en-Y gastric bypass.

BACKGROUND: Maternal metabolic profile and nutritional course of pregnancy after bariatric interventions is incompletely known. Their impact on birth weight has also not been hitherto addressed. Aiming to document such variables, a retrospective study was undertaken. METHODS: Women previously submitted to silastic ring Roux-en-Y gastric bypass, who conceived after 0-5 years (n = 14), were investigated. Intake of selected macro- and micronutrients, representative laboratory measurements, and correlation of these findings with birth weight and time to conception was documented. RESULTS: Mean calorie intake was restricted to about 1,800 kcal/day. Protein (71 +/- 17 g/day) and supplementary iron (60 mg/day) were barely adequate, and calcium and vitamin B(12) did not meet current recommendations, only folic acid being optimal. Biochemical monitoring reflected these inconsistencies, with occasional low values for serum albumin (4.1 +/- 0.4 g/dL), hemoglobin (11.4 +/- 1.5 g/dL), iron (78 +/- 50 mug/dL) and vitamin B(12) (193 +/- 102 pg/mL) but not folate. Lipids, glucose, and uric acid were much better than before the anti-obesity intervention. Reduced plasma lipids, glucose, and uric acid were associated with larger birth weight, albeit within the normal range. CONCLUSIONS: (1) Anemia as well as additional nutritional deficits during pregnancy were not totally eliminated, despite dietary guidance and micronutrient supplementation; (2) alleviation of metabolic comorbidities was demonstrated, and improved normalization predicted higher birth weight; (3) energy and folate intake was sufficient, but other nutrients probably did not reach ideal levels; (4) recent dietary guidelines for this population represent a step forward, but additional studies are needed.

Body weight changes and outcome of pregnancy after gastroplasty for morbid obesity.

BACKGROUND: Pregnancy is usually contraindicated in the first 18 months after anti-obesity operations because of nutritional risk, but childbearing happens nonetheless, both before and after this period. OBJECTIVE: Aiming to document clinical outcome for mother and child, a retrospective study was undertaken. METHODS: Women submitted to gastroplasty who conceived after 0-5 years (n=14) were investigated. Calorie intake, maternal and neonatal weight profile, peripartum complications, and clinical course were documented. RESULTS: Age was 31.8+/-6.5 years, and conception occurred within 24.2+/-21.6 months. BMI before operation, in the first trimester of pregnancy, and about 42 months after operation was respectively 49.9+/-7.9, 35.8+/-5.5 and 34.7+/-11.0 kg/m(2). Energy but not protein ingestion during pregnancy was appropriate, and pregnancy weight gain was scattered along a wide range. Infants (n=16) were born with adequate gestational age (35.6+/-3.3 weeks), weight (3.2+/-0.5 kg) and Apgar score (8.1+/-0.8), and subsequent clinical course was favorable. However cesarean section was required by 64%, and unexpected maternal complications were registered. CONCLUSIONS: 1) Dietary compliance during pregnancy was not optimal, mean weight gain was high, and patients displayed various comorbidities, but infants were born in good conditions; 2) follow-up during 1-3 years pointed out that neonates grew normally, despite continuing maternal high-risk status; and 3) nutritional monitoring should be a priority and dietary guidelines are in clear demand, as current recommendations are sketchy or insufficiently tested within this context.