Identifier: TFG:886
Authors: Rodríguez Tomàs, Elisabet; Tuset Martínez, Anna
Abstract:
Background. The pregnancies in morbidly obese women are at high risk of developing pregnancy, delivery and postpartum complications. There are everyday more women in childbearing age who undergo bariatric surgery procedure, mainly the Roux-en-Y Gastrojejunal Bypass (RYGJBP) or the Sleeve Gastrectomy (SG), which implies the possibility of conceiving postoperatively. Therefore, there is an existent need to know the benefit-risk relationship of the surgery and the obstetrical and neonatal outcomes in order to do an appropriate therapeutic intervention and follow-up. Study design. From June 2015 to February 2016, we have done a systematic review of 17 publications in which the authors studied the possible complications and benefits of the bariatric procedures mentioned on the obstetrical and neonatal outcomes. Objective. To compare the neonatal effects before and after the mother has undergone the RYGJBP or the SG. Results. Regarding the maternal obesity prevalence, we have not found enough scientific evidence that allows us to state that there is a lower rate of it after undergoing one of those surgical procedures, nor about the hypothesis of higher pregnancy prevalence after bariatric surgery. Furthermore, we cannot confirm such premise. The maternal complications during pregnancy differed between the two groups. On the one hand, the hypertensive disorders and gestational diabetes (GD) frequencies were lower in women who underwent a RYGJBP. On the other hand, the cesarean section risk was similar in both exposed and not exposed to surgery women. Taking the risk of prematurity into account, there were authors who stated that it was reduced after the surgical intervention, whereas others believed that it was increased. Regarding the neonatal outcomes, the RYGJBP significantly diminished the risk of macrosomic and large for gestational age (LGA) neonates (p<0.05), but, at the same time, it significantly increased the risk of small for gestational age neonates (SGA) (p<0.05). Comparing both groups, the total birth weight average was 3328.23 g, the birth weight average of neonates from operated women was 3153.33 g and it was 3478.14 g in those born from control women (p=0.003). The risk of developing congenital malformations showed no statistically significant differences between groups (p>0.05). The iron deficiency was higher after a RYGJBP than after a SG. We have also seen that the RYGJBP contributed in developing vitamin D deficiency. Finally, most of the authors recommended waiting from 12 to 18 months after the surgery to conceive, in order to avoid complications caused by the massive weight loss during that time interval. Nevertheless, significant differences regarding those complications have not been shown between women who certainly waited that time interval and those who did not do so. Conclusions. We have not been able to determine if there is a higher prevalence of pregnancies after a RYGJBP or a SG due to the lack of evidence in the scientific literature. The women who underwent a Roux-en-Y gastrojejunal bypass suffer from less hypertensive disorders and gestational diabetes than those who were not operated. In contrast, the rate of cesarean sections is similar in both groups and, finally, there is controversy with the risk of prematurity, given that some authors state that it diminishes postoperatively and some others do not. Operated mothers show a lower risk of having macrosomic and LGE offspring, but also a higher risk of having SGE neonates. We can state that neonates from women who underwent surgery have a significantly lower birth weight than those from the control group. The iron and vitamin D deficiency are higher after a RYGJBP. Finally, the recommended surgery-to-conception interval in order to obtain better materno-fetal outcomes rises from 12 to 18 months, even though there is not enough evidence to back up this premise. Key words: Roux-en-Y Gastrojejunal Bypass; Sleeve Gastrectomy; gestation; neonatal outcomes; obstetrical outcomes.
Repositori URV