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Malnutrition risks

Female adolescent gastric bypass patients face increased risk of neural tube defects

Malapsorption might lead to developmental problems for the children of young female gastric bypass patients

There is a possible link between gastric bypass surgery in adolescent girls and an increased risk for neural tube defects in their children, according to a case study presented at the Academy of Pediatrics National Conference and Exhibition in San Francisco, CA. Neural tube defects can lead to varying degrees of disability such as paralysis and mental retardation due to damage to the nervous system. 

The report, ‘Neural Tube Defects: An Unforseen Consequence of Gastric Bypass Surgery in Young Female Patients?’ reviewed the case of a young patient who had undergone gastric bypass surgery prior to becoming pregnant. She presented to the Fetal Treatment Center at UCSF Benioff Children's Hospital to discuss the possibility of fetal surgery as her fetus had spina bifida.

A literature review found six additional documented cases of children born with neural tube defects thought to be due to maternal nutritional deficiencies, particularly malabsorption, following bypass surgery.

Gastric bypass surgery can lead to malabsorption, causing multiple nutritional deficiencies, including folate (folic acid), which is a key element in the prevention of neural tube defects. Despite daily folate replacement being supplied to reverse this deficiency, adolescents rarely comply with medication regimens. This situation is especially critical because adolescents who have undergone gastric bypass surgery are at an increased risk of unintended pregnancies.

“We postulate that the malabsorption of folate, poor compliance with nutritional supplements and a higher risk of unintended pregnancies places young women at an increased risk for pregnancies complicated with neural tube defects," said senior study author Dr Diana L Farmer. “Although obesity is epidemic in this country, we believe non-reversible gastric bypass surgery should be avoided in adolescent women given the potential increased risk of fetal neural tube defects. 

However, she added that if gastric bypass is performed on an adolescent female, great efforts should be made to minimise the risks of both unintended pregnancies and nutritional deficiencies. This should include extensive pre-surgery counseling and frequent post-operative follow-up, as well as consideration of highly efficacious contraceptives such as an intra-uterine device.

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