title: Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution.
abstract: BACKGROUND
  Nutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes after bariatric surgery is an important issue that warrants further study. The objective of this study was to investigate pregnancy outcomes and nutritional indices after restrictive and malabsorptive procedures.
  
  
  METHODS
  We investigated pregnancy outcomes of 113 women who gave birth to 150 children after biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 presurgery pregnancies in 36 women of the same group.
  
  
  RESULTS
  Anemia was observed in 24.2% and 15.6% of pregnancies after BPD and RYGB, respectively. Vitamin B12 levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined as<2500 g. A comparison of neonatal data between babies born before surgery and siblings born after surgery (AS) showed that AS newborns had lower average birth weight with no significant differences in body length or head circumference and no cases of macrosomia.
  
  
  CONCLUSIONS
  Our study showed reasonably good pregnancy outcomes in this sample population after all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies after malabsorptive procedures especially regarding protein nutrition.
authors.affiliation: Nutrition Support and Morbid Obesity Unit, Department of Surgery, School of Medicine, University of Patras, Greece; Nutrition Department, University Hospital of Patras, Greece. Electronic address: ncmead@upatras.gr.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Mead
authors.affiliation: Nutrition Department, University Hospital of Patras, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Sakkatos
authors.affiliation: Department of Medical Physics, School of Medicine, University of Patras, Greece.
authors.forename: George C
authors.initials: GC
authors.lastname: Sakellaropoulos
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Patras, Greece.
authors.forename: George L
authors.initials: GL
authors.lastname: Adonakis
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, School of Medicine, University of Patras, Greece.
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Alexandrides
authors.affiliation: Department of Surgery, School of Medicine, University of Patras, Greece; Nutrition Support and Morbid Obesity Unit, Department of Surgery, School of Medicine, University of Patras, Greece.
authors.forename: Fotis
authors.initials: F
authors.lastname: Kalfarentzos
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015904:Biliopancreatic Diversion / Q000009:adverse effects* / Q000379:methods; D001724:Birth Weight; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods; D044342:Malnutrition / Q000209:etiology / Q000503:physiopathology; D008423:Maternal Age; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014806:Vitamin B 12 Deficiency / Q000209:etiology / Q000503:physiopathology; D015431:Weight Loss
keywords: Anemia; Bariatric surgery; Birth weight; Folic acid; Gestational age; Macrosomia; Neonatal outcomes; Nutritional indices; Pregnancy; Protein malnutrition; Vitamin B(12)