Faculty at Weill Cornell Medicine – Qatar (WCM-Q) have contributed to new guidelines to advise on the care of pregnant women who have had bariatric surgery to treat obesity.
The majority of bariatric surgeries are carried out to reduce the capacity of the stomach which in turn reduces food intake and results in substantial weight loss.
The procedure is increasingly carried out in women who are of childbearing age.
Twenty experts from across the world have now conducted a systematic review of the available research papers to offer guidance on a range of issues which may affect bariatric surgery patients who are pregnant or trying to conceive, including contraception, diet, nutrient levels, gestational weight gain, and breast feeding.
Dr Shahrad Taheri, professor of medicine and director of clinical research at WCM-Q, was one of experts to contribute to the paper, entitled ‘Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care.’
Dr Taheri said, “Bariatric procedures are increasingly available and cause physiological changes in the body that change processes like energy balance and fat metabolism. Pregnancy is a major physiological and nutritional challenge so the health of pregnant women who have undergone bariatric surgery. There needs to be careful monitoring to ensure that women receive sufficient nutrients to allow them and the fetus to grow and remain healthy.”
For women, obesity increases the possibility of complications during pregnancy, and poor maternal nutrition can have a long-lasting impact on the infant, so it is recommended that women try to lose weight before conceiving. In addition, the report states that men should also lose weight if they and their partner are trying to have children.
Other guidance includes the advice that women who have undergone bariatric surgery should postpone pregnancy until their weight has stabilised and that quickly absorbed carbohydrates should be avoided; meals should instead comprise protein and low-glycemic index alternatives.
As with standard pregnancies, expectant mothers should take a variety of supplements, and their levels of micronutrients monitored before they conceive and then during each trimester. But the systematic review found that breast milk is not compromised after bariatric surgery and that breastfeeding should be encouraged.
Dr Taheri said,“Pregnancy can be a confusing time for all first-time mothers with a lot of information to absorb about optimal nutrition, supplements and exercise alongside the fact that the body is physically changing and has different requirements. This confusion can be compounded for pregnant women who have undergone weight-loss surgery, and by contributing to this first international guideline, I and my colleagues hope that we can simplify the messages being delivered and offer some reassurance to expectant mothers.”
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