title: Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects.
abstract: OBJECTIVE
  Bariatric surgery results in decreased food intake and a variable degree of malabsorption. Without adequate supplementation, the most common complications of this surgery are nutritional disorders. Pregnancy following surgery for obesity is a particular condition requiring strict monitoring of nutrient intake necessary for fetal development and a favourable neonatal prognosis.
  
  
  METHODS
  Malnutrition in pregnancy and congenital neural malformations are reported in three women who had previously undergone bariatric surgery (1, 5 and 18 years before pregnancy, respectively). Two patients underwent the Roux en Y bypass and one bilio-pancreatic diversion with gastroplasty. None of the three received pre-conceptional nutritional counselling. Patients 1 and 2 did not undergo postoperative nutritional surveillance; nutrient supplementation was started at 22 and 20 weeks gestation, respectively. In patient 3, supplementation was stopped at six weeks gestation.
  
  
  RESULTS
  Newborns 1 and 2 presented with dorsal myelomeningocele and ventricular dilation. Both underwent surgery and a ventriculo-peritoneal shunt was inserted in the first month of life. Newborn 3 had microcephaly, bilateral microphthalmia and sensorineural deafness.
  
  
  CONCLUSIONS
  Diet and nutritional status, before and during pregnancy, play an important role in the early processes of fetal development and neonatal outcome. Women of childbearing age who have had bariatric surgery, should be encouraged to follow a well-balanced diet as part of a weight management strategy. They should be advised to take recommended maternal supplements.
authors.affiliation: Department of Maternal and Children's Health, Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo and University of Pavia, P,le Golgi 2, Pavia 27100, Italy. g.pelizzo@smatteo.pv.it.
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra
authors.forename: Mario
authors.initials: M
authors.lastname: Fusillo
authors.forename: Ghassan
authors.initials: G
authors.lastname: Nakib
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Ierullo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Alfei
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.forename: Mauro
authors.initials: M
authors.lastname: Stronati
authors.forename: Hellas
authors.initials: H
authors.lastname: Cena
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008591:Meningomyelocele / Q000209:etiology; D009436:Neural Tube Defects / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology