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SUCCESSFUL MANAGEMENT OF PREGNANCY AFTER BARIATRIC SURGERY Remesova T Jones L, Heath D, Sufi P Bariatric Surgery Department Whittington Hospital, London. United Kingdom
SUCCESSFUL MANAGEMENT
OF PREGNANCY
AFTER BARIATRIC SURGERY
Remesova TJones L, Heath D, Sufi P
Bariatric Surgery DepartmentWhittington Hospital, London. United Kingdom
WHAT ALGORITHM IS OPTIMAL?
• Nutrition• Surgical issues• Obstetrical issues
WHAT ALGORITHM IS OPTIMAL?
• Nutrition• Surgical issues• Obstetrical issues
WHAT NEW YOU WILL HEAR? Local algorithm
Roles in the multidisciplinary team – dietician, surgeon, obstetrician/midwife
20 patients, 22 pregnancies
1 week to 36 months post operatively
1. DIETICIAN Adjustment of supplements – vitamin A
Eating habits
Nutrition
Blood profile Zinc
B12 / folic acid
Haemoglobin / iron
Vitamin D
2. SURGEON
Band adjustment
Potential surgical issues
RESTRICTIVE
Gastric BAND SLEEVE gastrectomy
Stretching the pouch
Band adjustmentBand slippage
Stretching the pouch
RESTRICTIVE & MALABSORBTIVE
Gastric BYPASS Duodenal SWITCH / Biliopancreatic bypass
Malnutrition Internal hernias Ulcers
3. OBSTETRICIAN / MIDWIFE Obesity + O&G risk assessment
Avoid oGTT in malabsorbtive procedures
Avoid preferably oral contraceptive
Immediate referral to dietician
Low threshold for surgical referral
Ideal weight 0 months 6 months 12 months 24 months 5 years
65 kg 140 kg 105 kg 95 kg 75 kg 90 kg
ALGORITHMDietician Surgeon Obstetrician /
Midwife
(Pre )Conception Supplement adjustment
contraception Referral to bariatric dietician
1.Trimester Bloods Follow up as indicated (FU)
2. Trimester Bloods FU
3. Trimester Bloods Deflate band FU
Post partum Supplement adjustment
Inflate band
OUR RESULTS
Early referrals good outcome
Late referral IUGR CS 30 weeks
Frequent vitamin deficiencies corrected
2 subsequent pregnancies in two years no weight loss
