Pesquisa publicada no Congresso da IFSO em 2002, SP.

COMPARED EVOLUTION IN TWO CASES OF PREGNANCY AFTER

ROUX-EN-Y GASTRIC BYPASS

 

Background:  Pregnancy after grastroplasty is not indicated before eighteen months post-surgery due to a high rate of gestational diabetes, hypertension, thrombosis, pre-eclampsia, spontaneous abortion, neonatal macrosomia (> 4kg) in obese women, in addition to numerous nutritional deficiencies that may jeopardize both the development of the fetus and the mother’s health. The demand of vitamins and minerals naturally increases during pregnancy, and more significantly so after a Roux-en-Y gastric bypass.

Methods:

CASE 1: Thirty-three year old patient, pregnant one month after a Roux-en-Y gastric bypass.  The patient had already given birth (normal-term) to two boys whose average weight at birth was 3 kg.  The patient was guided in terms of nutrition, and nutritional supplementation with iron, cobalamine, and folate, plus specific macro and micronutrients for that phase.  She was checked for nutritional deficiencies through subjective exams (physical exam, 24-hour food intake record), and objective ones as well (lab analyses, weight, BMI), quarterly during pregnancy.

CASE 2:  Twenty-eight year old patient, pregnant of twins two years after a Roux-en-Y gastric bypass.  She got pregnant through in vitro fertilization since the father had been submitted to a vasectomy.  The patient had already given birth (normal-term) to a boy and a girl whose average weight at birth had been 2.5 kg.  The same methods of evaluation as the previous patient were employed.

Results:

DATA CASE 1 CASE 2
1st quarter 2nd quarter 3rd quarter 1st quarter 2nd quarter 3rd quarter
Weight (Kg) 107 96 85 72.4 81.7 90.8
BMI (Kg/m2) 40 35.2 31.2 22.9 25.8 28.7
Calorie intake (Kcal/d) 600 900 1521** 1600** 1720** 1800**
Nutritional deficits Anemia Anemia Anemia + lack of protein Anemia Anemia + lack of protein Anemia + lack of protein

Supplement intake

Irregular* Irregular* Irregular* Irregular* Irregular* Irregular*
Infant’s weight at birth Normal term; 3,080g 35 weeks

Girl – 2,150g

Boy – 2,500g

 

** Hyperproteic diet, lacking vitamins and minerals, inadequate liquid intake.

* Water and fat-soluble vitamins, calcium, zinc, magnesium, iron and protein complex prescribed, but not complied with by patients (an average of three times/week).

 

 

Conclusion:

We have concluded that a woman may have a normal pregnancy after the Roux-en-Y gastric bypass, even with the following progressive weight loss, provided that correct nutritional care is taken in order to maintain both the mother’s and the fetus’ health, to avoid possible nutritional deficiencies which are common both after surgery and during pregnancy.

 

REFERÊNCIAS BIBLIOGRÁFICAS:

  1. DEITEL, M, STONE, E, TO,TB. Gynecologic-obstetric abnormalities of morbid obesity, and changes after loss of massive excess weight. In: DEITEL, M, ed Surgery for the Morbidly Obese Patient. Philadelphia: Lea & Febiger 1989: 359-364.
  2. DEITEL, M, STONE, E, KASSAM, H A et al. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr 1988; 7:147-153.
  3. TREADWELL, L, MASON, EE, SCOTT DA. Pregnancy outcome after vertical banded gastroplasty. Obes Surg 1993; 3:143.
  4. WITTGROVE AC, JESTER L, WITTGROVE P, et al Pregnancy following gastric bypass for morbid obesity. Obes Surg 1998: 8:461-464.
  5. DEITEL, M, COWAN JR, GSM (Ed.): Update: Surgery for the morbidly obese

patient, Toronto, FD – Communications, 481-486, 2000.