In pregnancy programming: bariatric surgery vs. medical treatment with drugs

Abstract

The increase in the prevalence of obesity in the world is alarming. Obesity and overweight that occur before and during pregnancy constitute an important risk factor for maternal and fetal complications.

First of all, we must know that obesity affects fertility because the increase in fat storage generates a decrease in the transporter protein and consequently an increase in circulating androgens and estrogens, all of which leads to hirsutism, oligo/amenorrhea, anovulatory cycles. , presence of polycystic ovary syndrome and infertility¹.

Bariatric surgery is the surgical treatment of morbid obesity and one of the possibilities to resolve obesity prior to pregnancy. The type of bariatric procedure is important in relation to possible gestational complications.

Pregnancy is a normal physiological state in which nutrient demands are increased to sustain fetoplacental growth and development. In women who underwent bariatric surgery (BC) and who plan a pregnancy, nutritional evaluations should be carried out in the stage prior to conception and during pregnancy until delivery, so that deficiencies of macro and micronutrients² can be corrected, if they exist.

Although there is no clear evidence showing greater fetal morbidity when pregnancy occurs during the first year after surgery, some authors have found a greater risk of premature birth and spontaneous abortion when pregnancies occur within the first 12 months after bariatric surgery, while other authors found no significant differences^3,4.

Most of the recommendations agree in avoiding pregnancy in the first 12 to 18 months post surgery. However, some groups do not recommend waiting, especially if they use restrictive procedures, since less nutrient deficiency was observed than with gastric bypass⁵.

What is clear is that patients who become pregnant within the first year after BS need strict monitoring of their weight, nutritional status, and fetal growth.

An important point to take into account is: how and what is the best tool for the diagnosis of gestational diabetes after bariatric surgery since the oral glucose tolerance test (OGTT) cannot be implemented in this group of patients.