Barrier surgery raises the birth rate, but the study’s findings suggest delaying pregnancy until weight loss stabilizes and vitamin status normalizes. Regular monitoring of vitamin status and vitamin supplements is therefore recommended.

In a firm message, the authors of a new systematic review և meta-analysis on the impact of bariatric surgery on women’s health. the period between surgery and pregnancy. (1)

The recommendations are based on the conclusion that invasive weight loss procedures are associated with vitamin deficiency in patients. They say that malnutrition associated with surgery is a “compelling reason” that it is recommended to delay it “until the physiological concentrations of the vitamin return or are maintained.” The authors address the need for global (vitamin) supplementation guidelines for women who have undergone bariatric surgery for weight loss during pregnancy.
The authors of all these meta-analyzes, from Erasmus University Medical Center in Rotterdam, first concluded that different types of bariatric surgery are indeed associated with a significant improvement in fertility, the restoration of the menstrual cycle, which is a promising positive result for women. wanting a mother who has had or is thinking about such procedures. Moreover, the results did not show an increased risk of short-term abortion or miscarriage.

One third of women of reproductive age (34%) are classified as obese, and the consequences for pregnancy are well documented. Outbreaks appear to be exacerbated during pregnancy and in patients with obesity (higher risk of preterm birth, preeclampsia) and subsequent obesity and subsequent cardiovascular disease.

Bariatric surgery, widely used by health services, is considered to be the most effective, indeed, the only long-term solution for weight loss in patients with a BMI greater than 40:. On the other hand, it is not a magic ball. Rapid weight loss from such interventions can lead to malnutrition, inhibiting the absorption of vitamins and minerals, with consequences for the developing mother և developing fetus.

There have been several systematic reviews of bariatric surgery on women’s reproductive health. The latter really highlighted the increased risk of micronutrient deficiencies. (2) However, the overall focus has been on pregnancy complications, not just maternal health during pregnancy, which was the purpose of this latest analysis.
The findings were based on a review of 51 study reports published as of November 1, 2020, of women undergoing weight loss surgery. The focus was on the health effects of depression, which the authors identified as 14 weeks before and 10 weeks after conception. Six of the studies analyzed reported insufficient absorption procedures (eg, biliopancreatic deviation), 11 restrictive procedures (eg, gastrectomy), և 37 studied combined surgeries (eg, gastric bypass), or no type of surgery.

Topics included endocrine changes after surgery, fertility, vitamin status contraception և in the first trimester, irregular menstrual cycles և prevalence of miscarriages in the first trimester. Congenital malformations were also included, as most begin during the first 10 weeks of fetal development. Articles were excluded that included only PCOS patients on the grounds that hormone status could affect the “outcome” of bariatric surgery.

The results showed that both fat and water-soluble vitamin deficiencies “regularly” occur after bariatric surgery, regardless of the type of procedure (for example, vitamin B12 is reduced in the first trimester of pregnancy). However, no short-term risks were found for reproductive perception effects such as increased miscarriage (zero risk difference) or congenital malformations (RD 0.01). Studies before (after surgery) have shown that serum hormone levels return to normal, and menstrual cycles become more regular due to reduced infertility (for example, more natural concepts և better ART results). A separate meta-analysis of 20 studies confirmed this. Infertility decreased significantly (risk difference 0.24), menstrual irregularities improved (RD 0.24), with no link between bariatric surgery and congenital malformations.

So how do the authors explain the restoration of fertility? One of the possible suggestions is to return to the regularity of the menstrual cycle, which leads to natural fertilization, which in turn improves the results of pregnancy. There is a warning sign here. Surgery should result in “enough weight loss” to restore the menstrual cycle. Therefore, temporary procedures (for example, adjustable gastric banding) are not recommended.

Many of the studies analyzed in this review have not reported the results of one type of bariatric surgery in isolation. According to the authors, future research may provide this evidence “due to significantly different mechanisms – anatomical – physiological consequences.” In addition, there is work to be done on the long-term effects of bariatric surgery on women’s health, such as whether endocrine-related changes may affect menopausal age.

Snoek K, Steegers-Theunissen R, Hazebroek E, et al. The effects of bariatric surgery on maternal perception health. Systematic review ա meta-analysis. Hum Reprod Update 2021; doi: 10.1093 / humupd / dmab022:
2. Shawe J, Ceulemans D, Akhter Z, et al. Pregnancy after bariatric surgery. Consensus recommendations for conception, antenatal and postnatal care. Obes Rev 2019; 20; 1507–1522; doi / 10.1111 / obr.12927: