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

THANK YOU!

Tereza.Remesova@nhs.netObsGynae.net