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Pregnancy post-surgery

Pregnancy should be delayed for 12 months post-surgery

Patients should receive advice and information on reproductive issues

According to a literature review published in the journal The Obstetrician & Gynaecologist, women should wait at least 12 months before trying for a baby following bariatric surgery to avoid possible miscarriage.

The review, which examined the safety, advantages and limitations of bariatric surgery and multidisciplinary management of patients before, during and after pregnancy, also reported that patients require further advice and information on reproductive issues.

“An increasing number of women of child-bearing age are undergoing bariatric surgery procedures and need information and guidance regarding reproductive issues,” said Dr Rahat Khan, consultant obstetrician and gynaecologist, Princess Alexandra Hospital NHS Trust, Harlow, UK, and co- author of the review. "Increasingly, obstetricians, surgeons and primary care clinicians will be required to address questions posed by their patients regarding the safety of pregnancy after bariatric surgery.”

The study authors noted that there can be surgical complications during pregnancy following bariatric surgery, with one previous study reporting band slippage, migration and band in 24% of pregnancies.

They also cite a second study that found a higher spontaneous miscarriage rate among pregnancies occurring within 18 months of having weight loss surgery, compared with those pregnancies occurring more than 18 months after surgery (31% versus 18%).

The authors therefore recommend that patients should not get pregnant for at least 12 months following bariatric surgery. The review also proposes that women should receive advice and information pre-conception on topics such as contraception, nutrition and weight gain and vitamin supplementation.

“In light of current evidence available, pregnancy after bariatric surgery is safer, with fewer complications, than pregnancy in morbidly obese women,” said Khan. “Multidisciplinary input care is the key to a healthy pregnancy for women who have undergone bariatric surgery. However, this group of women should still be considered high-risk by both obstetricians and surgeons.”

The report concludes that successful maternal and neonatal outcome requires a multidisciplinary team including obstetricians, surgeons, primary care clinicians, anaesthetists, fertility specialists, nutritionists, psychologists and plastic surgeons as well as patients themselves, before, during and after pregnancy following bariatric surgery.

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