Pregnancy Outcomes After Bariatric Surgery: Should We Favour Restrictive Procedures in Women of Reproductive Age?

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Introduction: Bariatric surgery (BS) is frequently performed in women of reproductive age, and is often associated with nutritional deficiencies and increased risk of adverse outcomes during pregnancy, such as small for gestational age (SGA) neonates.Whether we should favour restrictive procedures in this population, to minimize these risks, is still uncertain.Our aim was to evaluate the impact of the type of BS procedure on micronutrient deficiencies and on maternal and foetal outcomes during pregnancy.Methods: Single centre retrospective study, including a cohort of 47 pregnancies after BS, with follow up between 2008-2020.Neonates were classified as SGA if birth weight was <10th percentile.Data collection included type of surgery, body mass index (BMI) before surgery and before pregnancy, micronutrient levels and supplementation, and pregnancy outcomes (anaemia, preeclampsia, gestational diabetes, caesarean delivery, abortion, pre-term delivery, SGA). Results:The more frequently performed procedures were gastric bypass (36.2%) and sleeve gastrectomy (36.2%), followed by adjustable gastric banding (23.4%) and biliopancreatic diversion (4.2%).BMI mean reduction from surgery to pregnancy was higher in malabsorptive procedures.The BS-toconception interval did not differ between surgery types.Micronutrient deficiencies were frequent during pregnancy (vitamin D: 75.9%, calcium: 43.8%, vitamin B12: 23.5%, folic acid: 8.7%, iron: 77.8%), despite multivitamin supplementation in most women.The prevalence of SGA neonates was elevated (26.3%).There were no differences considering micronutrient deficiencies or pregnancy outcomes between surgical procedures.The prevalence of SGA neonates was increased in the presence of vitamin B12 deficiency in the first trimester of pregnancy (33.3 vs 0.0%, p=0.027) and in pregnant women not supplemented with iron in addition to multivitamins (46.2% vs 14.8%, p=0.052).Conclusion: Micronutrient deficiencies were frequent, despite multivitamin supplementation.Micronutrient deficiencies and pregnancy outcomes were similar between BS procedure types.Our results suggest that in lieu of favouring restrictive procedures in women of reproductive age, the procedure decision should be based on individual characteristics.Following BS, women should be monitored and supplemented using a close individualized approach during pre-conception and pregnancy.

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