Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects
1 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
2 Department of Internal Medicine, University of Pavia and Department of Maternal and Children’s Health, Pediatric Unit, Fondazione IRCCS Policlinico San Matteo Pavia, P.le Golgi 2, Pavia 27100, Italy
3 Department of Maternal and Children’s Health, Obstetrics and Gynecology Unit, Fondazione IRCCS Policlinico San Matteo Pavia and University of Pavia, P.le Golgi 2, Pavia 27100, Italy
4 Department of Maternal and Children’s Health, Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo Pavia, P.le Golgi 2, Pavia 27100, Italy
5 Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Cascina Cravino, Pavia 27100, Italy
Nutrition Journal 2014, 13:59 doi:10.1186/1475-2891-13-59Published: 14 June 2014
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.
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.
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.
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.