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Konstantinidou SK, Argyrakopoulou G, Dalamaga M, Kokkinos A. The Effects of Bariatric Surgery on Pharmacokinetics of Drugs: a Review of Current Evidence. Curr Nutr Rep 2023; 12:695-708. [PMID: 37857987 PMCID: PMC10766679 DOI: 10.1007/s13668-023-00498-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Obesity constitutes a major public health concern and has been recognized as an epidemic. To date, bariatric surgery remains the most effective way for substantial long-lasting weight loss in severe obesity. The purpose of this review is to summarize how the pharmacokinetics of drugs are affected by the most common types of bariatric surgery, i.e., Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). RECENT FINDINGS Limited data are available regarding the changes in pharmacokinetics of drugs after bariatric surgery. The lack of existing guidelines may lead patients to experience drug toxicity or therapeutic undertreatment. Pharmacokinetic parameters that need to be taken into consideration postoperatively include gastric motility, gastric volume, pH, surface area, bile secretions, carrier proteins, and first-pass metabolism. For drugs with a narrow therapeutic index, other factors need to be monitored closely, including plasma drug levels, patients' clinical outcomes, and laboratory markers. Patients should be followed up frequently and treated in accordance with their response to the drug therapy. Bariatric surgery may affect the pharmacokinetics of various drugs, due to the resultant anatomical changes and the substantial weight loss. Therefore, there is a need to identify those potential changes and adjust patients' medication doses in order to achieve higher efficacy and avoid toxicity.
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Affiliation(s)
- Sofia K Konstantinidou
- First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Maria Dalamaga
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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2
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McNamee K, Edelman A, Li RHW, Kaur S, Bateson D. Best Practice Contraception Care for Women with Obesity: A Review of Current Evidence. Semin Reprod Med 2022; 40:246-257. [PMID: 36746158 DOI: 10.1055/s-0042-1760214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of obesity among females of reproductive age is increasing globally. Access to the complete range of appropriate contraceptive options is essential for upholding the reproductive rights of this population group. People with obesity can experience stigma and discrimination when seeking healthcare, and despite limited evidence for provider bias in the context of contraception, awareness for its potential at an individual provider and health systems level is essential. While use of some hormonal contraceptives may be restricted due to increased health risks in people with obesity, some methods provide noncontraceptive benefits including a reduced risk of endometrial cancer and a reduction in heavy menstrual bleeding which are more prevalent among individuals with obesity. In addition to examining systems-based approaches which facilitate the provision of inclusive contraceptive care, including long-acting reversible contraceptives which require procedural considerations, this article reviews current evidence on method-specific advantages and disadvantages for people with obesity to guide practice and policy.
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Affiliation(s)
| | - Alison Edelman
- Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Raymond Hang Wun Li
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong
| | - Simranvir Kaur
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
| | - Deborah Bateson
- Faculty of Medicine and Health, Daffodil Centre, University of Sydney, Sydney, Australia
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3
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Cheah S, Gao Y, Mo S, Rigas G, Fisher O, Chan DL, Chapman MG, Talbot ML. Fertility, pregnancy and post partum management after bariatric surgery: a narrative review. Med J Aust 2022; 216:96-102. [PMID: 35034365 PMCID: PMC9306879 DOI: 10.5694/mja2.51373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Of the women who gave birth in Australia in 2018, 47% had overweight or obesity, with obesity being associated with both maternal and fetal complications. Bariatric surgery improves fertility and some pregnancy‐related outcomes. Following bariatric surgery, pregnancy should be delayed by at least 12–18 months due to adverse pregnancy outcomes associated with rapid weight loss. Contraception should be prescribed after bariatric surgery, although the effectiveness of the oral contraceptive pill may be reduced due to malabsorption and contraceptive devices such as intrauterine devices should be considered as first line therapy. After bariatric surgery, women should undergo close monitoring for nutritional insufficiencies before, during and after pregnancy. Expert opinion recommends these women undergo dietary assessment and supplementation to prevent micronutrient deficiencies. Bariatric surgeons, bariatric medical practitioners, bariatric dieticians, the patient’s usual general practitioner, obstetricians, and maternity specialists should be involved to assist in the multidisciplinary management of these complex patients.
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Affiliation(s)
| | | | | | | | - Oliver Fisher
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
| | - Daniel L Chan
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
| | | | - Michael L Talbot
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
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4
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Ciangura C, Bachelot A. [Contraception in women with obesity]. Med Sci (Paris) 2021; 37:882-887. [PMID: 34647876 DOI: 10.1051/medsci/2021147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Obese women are at high risk of unintended pregnancy. In addition, obesity is an important risk factor for venous thromboembolism events and arterial thrombosis. All of these data are to be considered in choosing a contraceptive method for obese women. The metabolic changes and the increased body mass of these women may be the cause of a reduction in the effectiveness of hormonal contraception. The progestin-only contraceptives (progestin only pills and etonogestrel subdermal implant) and the intra-uterine devices are the preferred contraceptive methods in women with obesity. The combined estrogen-progestin contraceptives may be proposed in young obese women without other cardiovascular risk factor. Obesity per se does not seem to increase the risk of failure of most contraceptive methods. Bariatric surgery is a complex situation. Contraception is needed for at least 12 months after surgery. Some bariatric surgery such as bypass can induce gastrointestinal malabsorption. In this situation, all oral contraceptives are not recommended because of a higher risk of failure.
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Affiliation(s)
- Cécile Ciangura
- Service de nutrition, ICAN (Institut de cardiométabolisme et nutrition), Hôpital Pitié Salpêtrière, Sorbonne Université, 47-83 boulevard de l'hôpital, 75013 Paris, France
| | - Anne Bachelot
- Endocrinologie et médecine de la reproduction, Centre de référence des maladies endocriniennes rares de la croissance et du développement, Centre de référence des pathologies gynécologiques rares, Hôpital universitaire Pitié Salpêtrière, 47-83 boulevard de l'hôpital, 75013 Paris, France
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5
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Kingma JS, Burgers DMT, Monpellier VM, Wiezer MJ, Blussé van Oud-Alblas HJ, Vaughns JD, Sherwin CMT, Knibbe CAJ. Oral drug dosing following bariatric surgery: General concepts and specific dosing advice. Br J Clin Pharmacol 2021; 87:4560-4576. [PMID: 33990981 PMCID: PMC9291886 DOI: 10.1111/bcp.14913] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/06/2021] [Accepted: 05/01/2021] [Indexed: 11/30/2022] Open
Abstract
Bariatric or weight‐loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended‐release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advice for oral drug therapy after bariatric surgery, implying that a risk assessment on a case‐by‐case basis is required for each drug.
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Affiliation(s)
- Jurjen S Kingma
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Desirée M T Burgers
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, The Netherlands
| | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Janelle D Vaughns
- Department of Anesthesia and Pain Medicine, Children's National Health System, Washington, DC, USA.,Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA
| | - Catherine M T Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.,Division of Systems Biomedicine & Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
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6
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Têtu C, Gaubil-Kaladjian I, Barbe C, Diaz Cives A, Barrois M, Bertin E, Delemer B, Fèvre A. [Contraception after bariatric surgery: Importance of a specific gynecologic course]. ACTA ACUST UNITED AC 2021; 49:709-715. [PMID: 33766790 DOI: 10.1016/j.gofs.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
- C Têtu
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France.
| | - I Gaubil-Kaladjian
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - C Barbe
- CHU de Reims, Unité d'aide méthodologique, Pôle recherche et santé publique, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - A Diaz Cives
- Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Service de chirurgie générale digestive et endocrinienne, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - M Barrois
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - E Bertin
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - B Delemer
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - A Fèvre
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
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7
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Różańska-Walędziak A, Bartnik P, Kacperczyk-Bartnik J, Czajkowski K, Walędziak M, Kwiatkowski A. Pregnancy after bariatric surgery - a narrative literature review. Wideochir Inne Tech Maloinwazyjne 2021; 16:30-37. [PMID: 33786114 PMCID: PMC7991924 DOI: 10.5114/wiitm.2020.99281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/10/2020] [Indexed: 12/30/2022] Open
Abstract
The purpose of this review was to analyze the literature about pregnancy after bariatric surgery. We searched for available articles on the subject from the last decade (2010 to 2020). The positive impact of bariatric surgery on the level of comorbidities and pregnancy and neonatal outcomes cannot be overrated. Weight loss after bariatric surgery reduces the incidence of obesity-related conditions in pregnancy. A pregnancy in a woman after bariatric surgery should be considered a high-risk pregnancy and taken care of by a multidisciplinary team with appropriate micronutrient and vitamin supplementation provided. Optimum time to conception should be chosen following the international recommendations. Every woman after bariatric surgery should be aware of symptoms of surgical complications and immediately contact their surgeon in case of abdominal pain.
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Affiliation(s)
| | - Paweł Bartnik
- 2 Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Krzysztof Czajkowski
- 2 Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Kwiatkowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
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8
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Ciangura C, Coupaye M, Deruelle P, Gascoin G, Calabrese D, Cosson E, Ducarme G, Gaborit B, Lelièvre B, Mandelbrot L, Petrucciani N, Quilliot D, Ritz P, Robin G, Sallé A, Gugenheim J, Nizard J. Clinical Practice Guidelines for Childbearing Female Candidates for Bariatric Surgery, Pregnancy, and Post-partum Management After Bariatric Surgery. Obes Surg 2020; 29:3722-3734. [PMID: 31493139 DOI: 10.1007/s11695-019-04093-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Emerging evidence suggests that bariatric surgery improves pregnancy outcomes of women with obesity by reducing the rates of gestational diabetes, pregnancy-induced hypertension, and macrosomia. However, it is associated with an increased risk of a small-for-gestational-age fetus and prematurity. Based on the work of a multidisciplinary task force, we propose clinical practice recommendations for pregnancy management following bariatric surgery. They are derived from a comprehensive review of the literature, existing guidelines, and expert opinion covering the preferred type of surgery for women of childbearing age, timing between surgery and pregnancy, contraception, systematic nutritional support and management of nutritional deficiencies, screening and management of gestational diabetes, weight gain during pregnancy, gastric banding management, surgical emergencies, obstetrical management, and specific care in the postpartum period and for newborns.
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Affiliation(s)
- Cécile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Nutrition and Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Explorations Fonctionnelles, Colombes, University Paris Diderot, Paris, France.,Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.,Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Société Française de Néonatologie et Société Française de Pédiatrie, Paris, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Digestive Surgery, Colombes, University Paris Diderot, Paris, France
| | - Emmanuel Cosson
- Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Bondy, 10 UMR U557 INSERM/U11125 INRA/CNAM, University Paris13, Bobigny, France.,Société Francophone du Diabète (SFD), Paris, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Departemental Hospital, La Roche-sur-Yon, France
| | - Bénédicte Gaborit
- Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France.,Assistance Publique-Hôpitaux de Marseille, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, INSERM, INRA, C2VN, Aix Marseille University, Marseille, France
| | - Bénédicte Lelièvre
- Laboratory of Pharmacology and Toxicology, Angers University Hospital, Angers, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, University Paris Diderot, Paris, France
| | - Niccolo Petrucciani
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Division of Digestive Surgery and Liver Transplantation, UPEC University, Créteil, France
| | - Didier Quilliot
- Department of Diabetology-Endocrinology-Nutrition, CHRU Nancy, INSERM 954, University of Lorraine, Nancy, France.,Société Francophone Nutrition Clinique et Métabolisme (SFNCM), Paris, France
| | - Patrick Ritz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital, UMR1027, Paul Sabatier University, Toulouse, France
| | - Geoffroy Robin
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France.,Department of Medical Gynecology, and Sexology and Department of Assisted Reproductive Technologies and Fertility Preservation, Jeanne de Flandre Hospital, Lille, EA4308 "gametogenesis and gamete quality", Lille University, Lille, France
| | - Agnès Sallé
- Department of Diabetology-Endocrinology-Nutrition, Angers University Hospital, Angers, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, University of Nice, Nice, France.,Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (SOFFCOMM), Porte des Pierres Dorées, France
| | - Jacky Nizard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Gynecology and Obstetrics, Sorbonne University, Paris, France
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9
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Shawe J, Ceulemans D, Akhter Z, Neff K, Hart K, Heslehurst N, Štotl I, Agrawal S, Steegers‐Theunissen R, Taheri S, Greenslade B, Rankin J, Huda B, Douek I, Galjaard S, Blumenfeld O, Robinson A, Whyte M, Mathews E, Devlieger R. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care. Obes Rev 2019; 20:1507-1522. [PMID: 31419378 PMCID: PMC6852078 DOI: 10.1111/obr.12927] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023]
Abstract
The objective of the study is to provide evidence-based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow-up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print-friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high-quality evidence and warrant further research. These areas are highlighted in the paper.
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Affiliation(s)
- Jill Shawe
- Faculty of Health & Human SciencesUniversity of PlymouthDevonUK
| | - Dries Ceulemans
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Zainab Akhter
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Karl Neff
- King's College Hospital NHS Foundation TrustLondonUK
| | - Kathryn Hart
- Department of Nutritional Science, Faculty of Health and MedicineUniversity of SurreyGuildfordUK
| | - Nicola Heslehurst
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic DiseasesUniversity Medical CentreLjubljanaSlovenia
| | - Sanjay Agrawal
- Department of Upper Gastrointestinal and Bariatric SurgeryHomerton University HospitalLondonUK
| | - Regine Steegers‐Theunissen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal MedicineErasmus MCRotterdamthe Netherlands
| | - Shahrad Taheri
- Weill Cornell Medicine in QatarQatar Foundation, Education CityDohaQatar
| | | | - Judith Rankin
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Bobby Huda
- Department of Diabetes and Metabolism, St. Bartholomew's Hospital and The Royal London HospitalBarts Health NHS TrustLondonUK
| | | | - Sander Galjaard
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal MedicineErasmus MCRotterdamthe Netherlands
| | - Orit Blumenfeld
- Israel Centre for Disease ControlMinistry of HealthJerusalemIsrael
| | - Ann Robinson
- Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
| | - Martin Whyte
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
| | - Elaine Mathews
- St. Richard's Hospital Bariatric Surgery Service, ChichesterWestern Sussex NHS Foundation TrustChichesterUK
| | - Roland Devlieger
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of Obstetrics, Gynaecology and ReproductionSt‐Augustinus Hospital WilrijkWilrijkBelgium
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10
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Grossesses après chirurgie bariatrique: recommandations pour la pratique clinique (groupe BARIA-MAT). NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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La anticoncepción en la mujer obesa. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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FSRH Guideline (April 2019) Overweight, Obesity and Contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-69. [PMID: 31053605 DOI: 10.1136/bmjsrh-2019-ooc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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13
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Abstract
Importance In the United States, 27% of reproductive-aged women are overweight, and 35% are obese. Until recently, contraceptive research excluded women greater than 130% of their ideal body weight. Gaps in data limit evidence-based decision making for effective contraceptive counseling and management in this rapidly growing population. Objectives The aims of this summary are to review the benefits, adverse effects, and risk factors associated with contraceptive methods in obese women, with special attention to effectiveness, and provide contraceptive management and counseling recommendations for best clinical practice. Evidence Acquisition We performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on contraceptive counseling and management in obese women in the United States. We reviewed the body of evidence with special attention to studies published since recent Cochrane and systematic reviews on this topic. Conclusions Contraceptive use is safer than pregnancy, especially for obese women who have increased pregnancy risks. Baseline health is compromised by obesity, but contraceptive risks remain low. Long-acting, reversible contraceptive methods offer superior effectiveness, minimal risk, and numerous noncontraceptive benefits across body mass index groups. No substantial evidence supports ineffectiveness of any method in obese women except oral emergency contraception and the patch. Pharmacokinetic changes of obesity associated with other oral methods do not seem to result in clinically significant declines in effectiveness. Future contraceptive efficacy studies should include obese women to better discuss their contraceptive needs. Relevance This review is beneficial for all providers caring for reproductive-aged women wanting to avoid unintended pregnancy.
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Kominiarek MA, Jungheim ES, Hoeger KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy Endorsed by the American College of Obstetricians and Gynecologists and the Obesity Society. Surg Obes Relat Dis 2017; 13:750-757. [DOI: 10.1016/j.soard.2017.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/30/2022]
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Abstract
OBJECTIVE Bariatric surgery offers a highly effective mode of treatment for obese patients. Some procedures such as bypass cause an alteration in normal gastrointestinal tract with possible consequences for the uptake of orally administered drugs. METHODS We assessed the literature to ascertain whether the use of oral drugs and especially oral contraceptives is effective and adequate after bariatric surgery. RESULTS The bioavailability of drugs could be affected by the solubility and pH of the modified medium after bariatric surgery and by the loss of gastrointestinal transporters. Bariatric surgery could potentially result in a transient change in the absorption of drugs such as analgesics, antibiotics, antiarrhythmics, anticoagulants, psychotropic, and oral contraceptive drugs. Effective contraception is especially critical in the postoperative period, and implants might be representing a safe contraceptive method in women undergoing bariatric surgery. CONCLUSION Each drug will have to be evaluated with respect to its site of absorption and its mechanism of absorption, with special attention on parameters influencing the effectiveness of the absorption processes.
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Affiliation(s)
- Joël Schlatter
- *Dr. Joël Schlatter, Service Pharmacie, Hôpital Jean Verdier - APHP, Hôpitaux Universitaires de Paris-Seine-Saint-Denis, Avenue du 14 juillet, 93140 Bondy, France,
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Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, Hjelmesæth J, Kinzl J, Leitner DR, Makaronidis JM, Schindler K, Toplak H, Yumuk V. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts 2017; 10:597-632. [PMID: 29207379 PMCID: PMC5836195 DOI: 10.1159/000481825] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/21/2017] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.
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Affiliation(s)
- Luca Busetto
- Department of Internal Medicine, University of Padova, Padova, Italy
- *Prof. Dr. Luca Busetto, Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy,
| | - Dror Dicker
- Department of Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Carmil Azran
- Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel
| | - Rachel L. Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- University College London Hospital Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Nathalie Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Martin Fried
- OB Klinika, Centre for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust and Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johann Kinzl
- Department of Psychiatry and Psychotherapy II, Medical University Innsbruck, Innsbruck, Austria
| | | | - Janine M. Makaronidis
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Karin Schindler
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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Srinivas NR. Impact of Roux-en-Y Gastric Bypass Surgery on Pharmacokinetics of Administered Drugs: Implications and Perspectives. Am J Ther 2016; 23:e1826-e1838. [DOI: 10.1097/mjt.0000000000000317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Graham Y, Wilkes S, Mansour D, Small PK. Contraceptive needs of women following bariatric surgery. ACTA ACUST UNITED AC 2016; 40:241-4. [PMID: 25240027 DOI: 10.1136/jfprhc-2014-100959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yitka Graham
- PhD Student, Department of Pharmacy, Health and Wellbeing, Faculty of Applied Sciences, University of Sunderland, Sunderland, UK
| | - Scott Wilkes
- Professor of General Practice and Primary Care, Department of Pharmacy, Health and Wellbeing, Faculty of Applied Sciences, University of Sunderland, Sunderland, UK
| | - Diana Mansour
- Consultant in Community Gynaecology and Reproductive Healthcare/Head of Clinical Service, Department of Sexual Health, New Croft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter K Small
- Consultant General Surgeon with Bariatric Interest, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
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19
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Simon C, Agier MS, Béné J, Muller C, Vrignaud L, Marret H, Jonville-Bera AP. [Safety profile of etonogestrel contraceptive implant (Nexplanon ® and Implanon ®) reported in France]. ACTA ACUST UNITED AC 2016; 45:1074-1082. [PMID: 27125380 DOI: 10.1016/j.jgyn.2016.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/18/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of the study was to assess the incidence of adverse effects (AE) reported with etonogestrel contraceptive implant in France (Implanon® and Nexplanon®). MATERIALS AND METHODS All cases of AE or unintended pregnancies reported to health authorities or to the firm were analyzed. RESULTS During 10 years, 5433 AE and 789 unintended pregnancies were reported. Only 388 (7 %) were serious. There were 1137 reports of difficulties to remove, failure to locate or migration, 430 of insertion difficulties and 203 of deformation or expulsion of the implant. Among other AE, the most common were 1694 gynecological AE, 524 skin reactions and 437 metabolic AE. Since the marketing of Nexplanon® which causes less deep insertions, the incidence of migrations, removal or insertion difficulties has decreased overall (0.92 vs. 1.31/1000 patients), particularly the incidence of removal difficulties, location failures or migrations (0.12 vs 1.01/1000). The infrequent but serious AE were infectious complications at the implant site and pregnancies. When the circumstances of the pregnancy were known, the contraceptive failure was due to the apparent inefficiency of the implant (n=224), to a technique failure (n=203) or to a drug-drug interaction (n=59). CONCLUSION This study confirms that AE of this implant are frequent but not serious, except for the pregnancies. The incidence of complications related to insertion decreased with Nexplanon®. Among other preventable AE, unintended pregnancies due to a drug-drug interaction would require to be better known by the practitioner.
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Affiliation(s)
- C Simon
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - M S Agier
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - J Béné
- Service de pharmacologie, centre régional de pharmacovigilance, CHRU de Lille, 59045 Lille, France
| | - C Muller
- Centre régional de pharmacovigilance, hôpital Civil, 67091 Strasbourg, France
| | - L Vrignaud
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - H Marret
- Service de gynécologie, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37032 Tours, France
| | - A P Jonville-Bera
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
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20
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Morrell KM, Cremers S, Westhoff CL, Davis AR. Relationship between etonogestrel level and BMI in women using the contraceptive implant for more than 1 year. Contraception 2015; 93:263-5. [PMID: 26577754 DOI: 10.1016/j.contraception.2015.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/09/2015] [Accepted: 11/09/2015] [Indexed: 11/16/2022]
Abstract
Progestin-only contraceptive methods, including the 3-year, single-rod etonogestrel (ENG) implant, may be preferred for obese women to avoid additional estrogen-related thrombosis risk; however, whether obese women receive an ENG sufficient dose to suppress ovulation is understudied. Our analysis expands on the limited information currently available by studying ENG levels related to body mass index (BMI) in a community sample of primarily Hispanic women. This cross-sectional, descriptive study of 52 long-term implant users found comparable ENG levels across a wide BMI range (p=.1). These results further support that ENG levels are independent of BMI through 3 years of implant use and are thus reassuring that ENG implants will be effective for women of all BMIs.
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Affiliation(s)
- Kathleen M Morrell
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th Street, PH 16-69, New York, NY, 10032, USA.
| | - Serge Cremers
- Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 W 168th Street, PH 10-105b, New York, NY, 10027, USA.
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology and Epidemiology, Columbia University Medical Center, 622 W 168th Street, PH 16-69, New York, NY, USA.
| | - Anne R Davis
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th Street, PH 16-69, New York, NY, 10032, USA.
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21
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Ciangura C, Nizard J, Poitou-Bernert C, Dommergues M, Oppert JM, Basdevant A. [Pregnancy and bariatric surgery: Critical points]. ACTA ACUST UNITED AC 2015; 44:496-502. [PMID: 25724602 DOI: 10.1016/j.jgyn.2015.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/26/2014] [Accepted: 01/19/2015] [Indexed: 02/03/2023]
Abstract
More than 200,000 people underwent obesity surgery in France. Most of them are women. Pregnancy after bariatric surgery is becoming a common situation. This surgery results in major nutritional and gastro-intestinal tract modifications that may influence or be influenced by pregnancy, and yields benefits as well as complications. A multidisciplinary management including a nutritionist, an obstetrician, an anesthesiologist, and a bariatric surgeon is required. The aim of this review is to analyze the impact of bariatric surgery on pregnancy and vice versa, and to identify the key points of this management.
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Affiliation(s)
- C Ciangura
- Pôle cœur et métabolisme, centre intégré de l'obésité, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Nizard
- Service de gynécologie obstétrique, hôpital de la Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - C Poitou-Bernert
- Service de nutrition, hôpital de la Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, 75013 Paris, France; Institute of cardiology metabolism and nutrition (ICAN), université Pierre-et-Marie-Curie, 75013 Paris, France
| | - M Dommergues
- Service de gynécologie obstétrique, hôpital de la Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - J M Oppert
- Pôle cœur et métabolisme, centre intégré de l'obésité, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Institute of cardiology metabolism and nutrition (ICAN), université Pierre-et-Marie-Curie, 75013 Paris, France
| | - A Basdevant
- Pôle cœur et métabolisme, centre intégré de l'obésité, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Institute of cardiology metabolism and nutrition (ICAN), université Pierre-et-Marie-Curie, 75013 Paris, France.
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Pocius KD, Dutton CR. Update on Hormonal Contraception and Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-014-0104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Merki-Feld GS, Skouby S, Serfaty D, Lech M, Bitzer J, Crosignani PG, Cagnacci A, Sitruk-Ware R. European Society of Contraception Statement on Contraception in Obese Women. EUR J CONTRACEP REPR 2014; 20:19-28. [DOI: 10.3109/13625187.2014.960561] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Utilizing contraception is critical in preventing unintended pregnancies among obese women. However, clinicians and obese patients may be unclear about which contraceptive methods are optimal. This review discusses the literature on any weight gain associated with contraceptive use, contraceptive efficacy among obese women, and special considerations for contraceptive method selection for women after bariatric surgery. The review also covers new findings on oral emergency contraception and obesity.
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Affiliation(s)
- Sheila K Mody
- Department of Reproductive Medicine, University of California San Diego, San Diego, California
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25
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Robinson JA, Burke AE. Obesity and hormonal contraceptive efficacy. WOMEN'S HEALTH (LONDON, ENGLAND) 2013; 9:453-66. [PMID: 24007251 PMCID: PMC4079263 DOI: 10.2217/whe.13.41] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women. Avoiding unintended pregnancy is of major importance, given the increased risks associated with pregnancy, but obesity may affect the efficacy of hormonal contraceptives by altering how these drugs are absorbed, distributed, metabolized or eliminated. Limited data suggest that long-acting, reversible contraceptives maintain excellent efficacy in obese women. Some studies demonstrating altered pharmacokinetic parameters and increased failure rates with combined oral contraceptives, the contraceptive patch and emergency contraceptive pills suggest decreased efficacy of these methods. It is unclear whether bariatric surgery affects hormonal contraceptive efficacy. Obese women should be offered the full range of contraceptive options, with counseling that balances the risks and benefits of each method, including the risk of unintended pregnancy.
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MESH Headings
- Bariatric Surgery
- Body Mass Index
- Contraceptive Agents, Female/pharmacokinetics
- Contraceptive Agents, Female/therapeutic use
- Contraceptive Devices, Female
- Contraceptives, Oral, Hormonal/pharmacokinetics
- Contraceptives, Oral, Hormonal/therapeutic use
- Contraceptives, Postcoital/pharmacokinetics
- Contraceptives, Postcoital/therapeutic use
- Counseling
- Drug Implants/pharmacokinetics
- Drug Implants/therapeutic use
- Estrogens/pharmacokinetics
- Estrogens/therapeutic use
- Female
- Humans
- Intrauterine Devices
- Obesity/metabolism
- Obesity/surgery
- Pregnancy
- Pregnancy, Unplanned
- Progestins/pharmacokinetics
- Progestins/therapeutic use
- Women's Health
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Affiliation(s)
- Jennifer A Robinson
- Department of Gynecology & Obstetrics, Johns Hopkins University Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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Merhi ZO. Revisiting optimal hormonal contraception following bariatric surgery. Contraception 2013; 87:131-3. [DOI: 10.1016/j.contraception.2012.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/15/2012] [Accepted: 06/21/2012] [Indexed: 11/28/2022]
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Mornar S, Chan LN, Mistretta S, Neustadt A, Martins S, Gilliam M. Pharmacokinetics of the etonogestrel contraceptive implant in obese women. Am J Obstet Gynecol 2012; 207:110.e1-6. [PMID: 22717269 DOI: 10.1016/j.ajog.2012.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/17/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We sought to examine the pharmacokinetics and acceptability of the etonogestrel contraceptive implant in obese women. STUDY DESIGN We developed and validated a plasma etonogestrel concentration assay and enrolled 13 obese (body mass index ≥30) women and 4 normal-weight (body mass index <25) women, who ensured comparability with historical controls. Etonogestrel concentrations were measured at 50-hour intervals through 300 hours postinsertion, then at 3 and 6 months to establish a pharmacokinetic curve. RESULTS All obese participants were African American, while all normal-weight participants were white. Across time, the plasma etonogestrel concentrations in obese women were lower than published values for normal-weight women and 31-63% lower than in the normal-weight study cohort, although these differences were not statistically significant. The implant device was found highly acceptable among obese women. CONCLUSION Obese women have lower plasma etonogestrel concentration than normal-weight women in the first 6 months after implant insertion. These findings should not be interpreted as decreased contraceptive effectiveness without additional considerations.
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Affiliation(s)
- Sara Mornar
- Department of Obstetrics and Gynecology, University of Chicago, IL 60637, USA
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