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

Abstract

Obesity, a public health problem, common in women of reproductive age; compromises maternal health during pregnancy with adverse effects that will affect fetal and newborn health and throughout life.

The prevalence of overweight/obesity in the population from 5 to 17 years of Argentina according to the National Survey of Nutrition and Health of 2019 is 41.1% and in women older than 18 years of 66% and 31.1% for overweight and obesity respectively.

Dysfunctional adipose tissue promotes a state of low-grade chronic inflammation with associated metabolic changes that favor medical complications and condition a high-risk pregnancy.

Its approach must be prior to conception and continue afterwards to ensure better maternal and fetal outcomes and prevent serious complications. Changes in lifestyle do not always achieve sufficient weight loss to improve ovarian function, fertility and ensure a healthy pregnancy, which is why the pregnancy must be scheduled and resort to pharmacological options for significant weight loss that results in a decrease in the risk of gestational diabetes, intervention should be performed prior to pregnancy, improve body weight to reach the early stages of pregnancy with a healthy gestational metabolic environment.

GLP-1 receptor agonists with results in terms of weight loss with improvements in abdominal circumference, body weight, insulin resistance markers, benefits on glucose and lipid metabolism, and on physical, psychological, and social health.

Let us remember that GLP-1AR are classified as C drugs, they are contraindicated during pregnancy, for which reason they should be discontinued prior to conception and contraception should be indicated when performing an intervention on body weight with drugs.