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Bechensteen BT, Sithiravel C, Strøm-Roum EM, Ruud HK, Kravdal G, Winther JA, Valderhaug TG. Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study. BMC Pregnancy Childbirth 2024; 24:229. [PMID: 38566061 PMCID: PMC10985986 DOI: 10.1186/s12884-024-06407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Maternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy. METHODS In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5). RESULTS The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030). CONCLUSION Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.
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Affiliation(s)
- Brit Torunn Bechensteen
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Cindhya Sithiravel
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | | | - Heidi Kathrine Ruud
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Gunnhild Kravdal
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | - Jacob A Winther
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
| | - Tone G Valderhaug
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway.
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Caredda C, St-Laurent A, Gagnon M, Harrison S, Bernier E, Gagnon G, Plante AS, Lemieux S, Bégin C, Marceau S, Biertho LD, Tchernof A, Provencher V, Drapeau V, Michaud A, Morisset AS. Attitudes and Behaviors towards Food and Weight in Late Pregnancy: A Comparative Approach between Individuals with and without Previous Bariatric Surgery. Healthcare (Basel) 2024; 12:342. [PMID: 38338227 PMCID: PMC10855954 DOI: 10.3390/healthcare12030342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
The aims of this study were to compare, between pregnant individuals with and without bariatric surgery: (1) eating behaviors, (2) intuitive eating components and, (3) attitudes towards weight gain. This retrospective study included data collected in healthy pregnant individuals with and without previous bariatric surgery who were recruited at the Centre Hospitalier Universitaire (CHU) de Québec-Université Laval. Pregnant individuals who underwent bariatric surgery (biliopancreatic bypass with duodenal switch [n = 14] or sleeve gastrectomy [n = 5]) were individually matched, for age (±0.4 years) and body mass index (BMI) (±0.3 kg/m2), with pregnant individuals who have not received bariatric surgery. In the second trimester, participants completed the Three Factor Eating Questionnaire (TFEQ) and the Intuitive Eating Scale 2 (IES-2). In the third trimester, participants completed the French version of the Pregnancy Weight Gain Attitude Scale assessing attitudes towards weight gain. Pregnant individuals who have had bariatric surgery had a higher score for flexible restraint and a lower score for situational susceptibility to disinhibition compared to individuals who have not had undergone bariatric surgery (2.89 ± 1.15 vs. 1.95 ± 1.31; p = 0.04 and 1.11 ± 1.29 vs. 2.79 ± 1.44, respectively; p < 0.001). Regarding intuitive eating, pregnant individuals who experienced bariatric surgery had a higher score for reliance on internal hunger and satiety cues and a lower one for unconditional permission to eat compared with those who had not experienced bariatric surgery (3.99 ± 0.81 vs. 3.30 ± 1.03; p = 0.02 and 3.28 ± 0.54 vs. 3.61 ± 0.68, respectively; p = 0.03). No difference in attitudes towards weight gain was observed between groups. Overall, pregnant individuals who had undergone bariatric surgery had different eating behaviors and intuitive eating components compared to pregnant individuals without bariatric surgery. These results need to be confirmed in further studies with larger sample sizes.
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Affiliation(s)
- Chloé Caredda
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- Axe Endocrinologie et Néphrologie, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 4G2, Canada
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
| | - Audrey St-Laurent
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- Axe Endocrinologie et Néphrologie, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 4G2, Canada
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
| | - Marianne Gagnon
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- Axe Endocrinologie et Néphrologie, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 4G2, Canada
| | - Stéphanie Harrison
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
| | - Emilie Bernier
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- Axe Endocrinologie et Néphrologie, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 4G2, Canada
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
| | - Geneviève Gagnon
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
| | - Anne-Sophie Plante
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- Axe Endocrinologie et Néphrologie, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 4G2, Canada
| | - Simone Lemieux
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
| | - Catherine Bégin
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada
| | - Simon Marceau
- Axe Obésité, Diabète de Type 2 et Métabolisme, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada; (S.M.); (L.D.B.)
| | - Laurent D. Biertho
- Axe Obésité, Diabète de Type 2 et Métabolisme, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada; (S.M.); (L.D.B.)
| | - André Tchernof
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
- Axe Obésité, Diabète de Type 2 et Métabolisme, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada; (S.M.); (L.D.B.)
| | - Véronique Provencher
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
| | - Vicky Drapeau
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- Département de Kinésiologie, Université Laval, Québec, QC G1V 0A6, Canada
| | - Andréanne Michaud
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
- Axe Obésité, Diabète de Type 2 et Métabolisme, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada; (S.M.); (L.D.B.)
| | - Anne-Sophie Morisset
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada (A.S.-L.); (M.G.); (S.H.); (E.B.); (A.-S.P.); (S.L.); (C.B.); (V.P.); (V.D.); (A.M.)
- Axe Endocrinologie et Néphrologie, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 4G2, Canada
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada; (G.G.); (A.T.)
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Różańska-Walędziak A, Walędziak M, Mierzejewska A, Skopińska E, Jędrysik M, Chełstowska B. Nutritional Implications of Bariatric Surgery on Pregnancy Management-A Narrative Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1864. [PMID: 37893582 PMCID: PMC10608240 DOI: 10.3390/medicina59101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/01/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
One in three women of reproductive age is obese. The mainstay treatment for obesity is bariatric surgery, and the following weight reduction results in a decrease in pregnancy adverse effects, including gestational diabetes mellitus, pregnancy-induced hypertension, and macrosomia. However, nutritional and vitamin deficiencies due to changes in the gastrointestinal tract after bariatric surgery are associated with an increase in the risk of fetal growth retardation and small for gestational-age neonates. The purpose of this review was to analyze the available recent literature on the subject of the management of pregnancy after bariatric surgery. We searched for available articles from 2007 to 2023 and chose articles of the greatest scientific and clinical value. Micronutrient, vitamin, and protein supplementation is recommended in the prenatal period and throughout the pregnancy. It is advised that pregnant women with a history of bariatric surgery should be provided with regular specialist dietary care. There is still a lack of recommendations about the optimum gestational weight gain after different types of bariatric surgery and for patients of different metabolic statuses. Women of reproductive age undergoing bariatric procedures should be provided with appropriate counseling about adequate contraception, the recommended time-to-conception interval, and the positive and negative influence of bariatric surgery on perinatal outcomes.
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Affiliation(s)
- Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (A.R.-W.); (A.M.); (E.S.)
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine—National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland
| | - Anna Mierzejewska
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (A.R.-W.); (A.M.); (E.S.)
| | - Ewa Skopińska
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (A.R.-W.); (A.M.); (E.S.)
| | - Malwina Jędrysik
- Department of Biochemistry and Laboratory Diagnostics, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (M.J.); (B.C.)
| | - Beata Chełstowska
- Department of Biochemistry and Laboratory Diagnostics, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (M.J.); (B.C.)
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Hedderson MM, Boller M, Xu F, Lee C, Sridhar S, Greenberg M. Pregnancy post-bariatric surgery: Improved outcomes with telephonic nutritional management program. Obes Res Clin Pract 2023; 17:144-150. [PMID: 36906488 DOI: 10.1016/j.orcp.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Pregnancies post-bariatric surgery are increasingly common. It is important to understand how to manage prenatal care in this high-risk population to optimize perinatal outcomes. OBJECTIVE To determine among pregnancies post-bariatric surgery whether participation in a telephonic nutritional management program was associated with improved perinatal outcomes and nutritional adequacy. STUDY DESIGN Retrospective cohort study of pregnancies post-bariatric surgery from 2012 to 2018. Participation in a telephonic management program with nutritional counseling, monitoring and nutritional supplement adjustment. Modified Poisson Regression estimated the relative risk using propensity score methods to account for baseline differences between the patients who participated in the program and patients who did not. RESULTS 1575 pregnancies occurred post-bariatric surgery, of which 1142 (72.5 % of pregnancies) participated in the telephonic nutritional management program. Participants in the program were less likely than non-participants to have a preterm birth (aRR 0.48, 95 % CI 0.35-0.67), preeclampsia (aRR 0.43, 95 % CI (0.27-0.69)), gestational hypertension (aRR 0.62, 95 % CI 0.41-0.93), and to have neonates admitted to a Level 2 or 3 (aRR 0.61, 95 % CI0.39-0.94; aRR 0.66, 95 % CI 0.45-0.97, respectively), after adjusting for the propensity score to account for baseline differences. Risk of cesarean delivery, gestational weight gain, glucose intolerance and birthweight did not differ by participation. Among 593 pregnancies with nutritional labs available, participants in the telephonic program were less likely to have nutritional inadequacy in late pregnancy (aRR 0.91, 95 % CI 0.88-0.94). CONCLUSION Participation in a telephonic nutritional management program post-bariatric surgery was associated with improved perinatal outcomes and nutritional adequacy.
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Affiliation(s)
- Monique M Hedderson
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Marie Boller
- The Permanente Medical Group, United States of America
| | - Fei Xu
- Kaiser Permanente Northern California Division of Research, United States of America
| | - Catherine Lee
- Kaiser Permanente Northern California Division of Research, United States of America
| | - Sneha Sridhar
- Kaiser Permanente Northern California Division of Research, United States of America
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Yang JC, Chen G, Du X. Benefits and Risks of Bariatric Surgery on Women's Reproductive Health: a Narrative Review. Obes Surg 2023; 33:1587-1595. [PMID: 36869973 DOI: 10.1007/s11695-023-06513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
Bariatric surgery (BS) is escalating as the most efficient and endurable therapy for severe obesity. Women's reproductive health is essential to women's quality of life and is receiving increasing attention. However, despite the high prevalence of BS among women, the effect of BS on reproductive health remains underemphasis. The purpose of this narrative review is to provide an overview of BS on women's reproductive health, including their reproductive health before, during, and after pregnancy. Although limited attention has been given, current evidence highlights the substantial implications of bariatric surgery on reproductive health and reminds us of the importance of adopting decision-making conversations about reproductive health before bariatric surgery.
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Affiliation(s)
- Jun-Cheng Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Gang Chen
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.,Department of General Surgery, The Second Clinical Medical College, The Fifth People's Hospital Affiliated to Chengdu University of Traditional Chinese Medicine, Chengdu, 610041, China
| | - Xiao Du
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China. .,Department of General Surgery, Ya'an People's Hospital, Yaan, 625000, China.
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