Skip to main content
Erschienen in: Obesity Surgery 5/2009

01.05.2009 | Research Article

Pregnancy Nutritional Indices and Birth Weight After Roux-en-Y Gastric Bypass

Erschienen in: Obesity Surgery | Ausgabe 5/2009

Einloggen, um Zugang zu erhalten

Abstract

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 B12 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 μg/dL) and vitamin B12 (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.
Literatur
1.
Zurück zum Zitat Taylor JL, O’Leary JP. Pregnancy following jejunoileal bypass. Effects on fetal outcome. Obstet Gynecol. 1976;48:425–7.PubMed Taylor JL, O’Leary JP. Pregnancy following jejunoileal bypass. Effects on fetal outcome. Obstet Gynecol. 1976;48:425–7.PubMed
2.
Zurück zum Zitat Sheiner E, Levy A, Siverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 2004;190:1335–40.CrossRef Sheiner E, Levy A, Siverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 2004;190:1335–40.CrossRef
3.
Zurück zum Zitat Karmon A, Sheiner E. Pregnancy after bariatric surgery: a comprehensive review. Arch Gynecol Obstet. 2008;277:381–8.CrossRef Karmon A, Sheiner E. Pregnancy after bariatric surgery: a comprehensive review. Arch Gynecol Obstet. 2008;277:381–8.CrossRef
4.
Zurück zum Zitat Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg 2008;18:1023–7.CrossRef Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg 2008;18:1023–7.CrossRef
5.
Zurück zum Zitat Scholl TO. Maternal nutrition before and during pregnancy. Nestle Nutr Workshop Ser Pediatr Program 2008;61:79–89.CrossRef Scholl TO. Maternal nutrition before and during pregnancy. Nestle Nutr Workshop Ser Pediatr Program 2008;61:79–89.CrossRef
6.
Zurück zum Zitat Supplementation with multiple micronutrients intervention trial (SUMMIT) Study GroupShankar AH, Jahari AB, et al. Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet 2008;371(9608):215–27.CrossRef Supplementation with multiple micronutrients intervention trial (SUMMIT) Study GroupShankar AH, Jahari AB, et al. Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet 2008;371(9608):215–27.CrossRef
7.
Zurück zum Zitat Gupta P, Ray M, Dua T, et al. Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. Arch Pediatr Adolesc Med. 2007;161:58–64.CrossRef Gupta P, Ray M, Dua T, et al. Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. Arch Pediatr Adolesc Med. 2007;161:58–64.CrossRef
8.
Zurück zum Zitat Goldenberg RL, Culhane JF. Low birth weight in the United States. Am J Clin Nutr. 2007;85:584S–590S.CrossRef Goldenberg RL, Culhane JF. Low birth weight in the United States. Am J Clin Nutr. 2007;85:584S–590S.CrossRef
9.
Zurück zum Zitat Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2006;(4):CD004905; Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2006;(4):CD004905;
10.
Zurück zum Zitat Ju H, Rumbold AR, Wilson KJ, et al. Borderline gestational diabetes mellitus and pregnancy outcomes. BMC Pregnancy Childbirth 2008 30;8:31.CrossRef Ju H, Rumbold AR, Wilson KJ, et al. Borderline gestational diabetes mellitus and pregnancy outcomes. BMC Pregnancy Childbirth 2008 30;8:31.CrossRef
11.
Zurück zum Zitat Yajnik CS, Deshmukh US. Maternal nutrition, intrauterine programming and consequential risks in the offspring. Rev Endocr Metab Disord 2008;9:203–11.CrossRef Yajnik CS, Deshmukh US. Maternal nutrition, intrauterine programming and consequential risks in the offspring. Rev Endocr Metab Disord 2008;9:203–11.CrossRef
12.
Zurück zum Zitat Grissa O, Ategbo JM, Yessoufou A, et al. Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia. Transl Res 2007;150:164–71.CrossRef Grissa O, Ategbo JM, Yessoufou A, et al. Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia. Transl Res 2007;150:164–71.CrossRef
13.
Zurück zum Zitat Faintuch J, Ishida RK, Ribeiro AS, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg 2007;142:962–8.CrossRef Faintuch J, Ishida RK, Ribeiro AS, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg 2007;142:962–8.CrossRef
14.
Zurück zum Zitat Subcommittee on Nutritional Status and Weigh Gain During Pregnancy. Nutrition during pregnancy. Washington, DC: Institute of Medicine, National Academy of Sciences; 1990. Subcommittee on Nutritional Status and Weigh Gain During Pregnancy. Nutrition during pregnancy. Washington, DC: Institute of Medicine, National Academy of Sciences; 1990.
15.
Zurück zum Zitat Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. Endocr Pract 2008;14(Suppl 1):1–83.CrossRef Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. Endocr Pract 2008;14(Suppl 1):1–83.CrossRef
16.
Zurück zum Zitat Molloy AM, Kirke PN, Brody LC, et al. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull 2008;29(2 Suppl):S101–11.CrossRef Molloy AM, Kirke PN, Brody LC, et al. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull 2008;29(2 Suppl):S101–11.CrossRef
17.
Zurück zum Zitat Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008;18:288–93.CrossRef Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008;18:288–93.CrossRef
18.
Zurück zum Zitat Kaiser L, Allen LH. American Dietetic Association. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2008;108:553–61.CrossRef Kaiser L, Allen LH. American Dietetic Association. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2008;108:553–61.CrossRef
19.
Zurück zum Zitat Giroux I, Inglis SD, Lander S, et al. Dietary intake, weight gain, and birth outcomes of physically active pregnant women: a pilot study. Appl Physiol Nutr Metab 2006;31:483–9.CrossRef Giroux I, Inglis SD, Lander S, et al. Dietary intake, weight gain, and birth outcomes of physically active pregnant women: a pilot study. Appl Physiol Nutr Metab 2006;31:483–9.CrossRef
Metadaten
Titel
Pregnancy Nutritional Indices and Birth Weight After Roux-en-Y Gastric Bypass
Publikationsdatum
01.05.2009
Erschienen in
Obesity Surgery / Ausgabe 5/2009
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-008-9755-9

Weitere Artikel der Ausgabe 5/2009

Obesity Surgery 5/2009 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.