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Weight Gain During Pregnancy: Reexaming the Guidelines
1998 to approximately 72,177 in 2002 (Santry et al., 2005; Davis et al., 2006). Most of the procedures during this time were performed on women; 81 percent in 1998 and 84 percent in 2002. As a result of this trend, the American College of Obstetricians and Gynecologists (ACOG) published a Committee Opinion on Obesity and Pregnancy addressing the issue of bariatric surgery and pregnancy (ACOG, 2005), recommending that obese women who have undergone bariatric surgery receive the following counseling before and during pregnancy:
Patients with adjustable gastric banding should be advised that they are at risk of becoming pregnant unexpectedly after weight loss following surgery.
All patients are advised to delay pregnancy for 12-18 months after surgery to avoid pregnancy during the rapid weight loss phase.
Women with gastric banding should be monitored by their general surgeons during pregnancy because adjustments of the band may be necessary.
Patients should be evaluated for nutritional deficiencies, including iron, B12, folate, vitamin D, and calcium, and supplemented with vitamins as necessary.
With respect to GWG, the committee identified three studies that reported a decrease in weight gain during a subsequent pregnancy in women who had bariatric surgery (Skull et al., 2004; Dixon et al., 2005; Ducarme et al., 2007). Gurewitsch et al. (1996) reported that nutritional complications such as folate and B12 deficiencies are also associated with pregnancy following bariatric surgery.
However, the committee did not identify any prospective randomized trials of pregnancy outcome in obese women treated by bariatric surgery. The only published reports are those that utilize the patient as her own control, i.e., a pregnancy outcome before bariatric surgery and a subsequent pregnancy outcome after having a bariatric procedure (Marceau et al., 2004; Skull et al., 2004; Dixon et al., 2005) or retrospective case-controlled studies (Ducarme et al., 2007). Skull et al. (2004), Dixon et al. (2005), and Ducarme et al. (2007) all reported a decreased incidence of GDM and hypertensive disorders among women who had undergone bariatric surgery prior to pregnancy. Marceau et al. (2004) and Ducarme et al. (2007) also reported a decreased risk of macrosomia in women following bariatric surgery; however, neither Dixon et al. (2005) nor Skull et al. (2005) reported a decrease in macrosomia. So the effects of bariatric surgery on risk for macrosomia, as well as on birth weight, are inconclusive. Care must be taken in the interpretation of these studies because of their retrospective nature and use of various definitions of outcome measures.