肥満と減量療法のジャーナル

抽象的な

A Focus on the Impact of Bariatric Surgery on Pregnancy Outcome: Effectiveness, Safety and Clinical Management

Nino Cristiano Chilelli, Silvia Burlina, MariaGrazia Dalfrà and Annunziata Lapolla

Due to the increase in obesity worldwide, nowadays about 1 in 5 women are obese when they conceive. Even if the International recommendations on weight gain during pregnancy recommend to treat obesity before a woman becomes pregnant, these suggestions often results fruitless due to the difficulty of losing weight, especially in cases of morbid obesity. On the contrary, bariatric surgery has proven to be the most effective long-term weight loss strategy in obese women in reproductive age. In this review we analyzed the more recent papers describing pregnancy outcome after bariatric surgery. In particular, we focused on weight loss procedures and their potential effects mainly on maternal complications, so to give a comprehensive view of the benefits and risks of post-surgery pregnancy. The present review is structured introducing the pros and cons associated with various surgical procedures, then analyzing the differences in maternal outcomes among pregnant women previously undergone bariatric surgery or not and finally concluding with a focus on the post-surgery clinical management aimed to reduce surgical complications, which may occur during future pregnancies. We concluded that outcome of pregnancy is favorable after bariatric surgery. However, the low number of patients in some studies and the fact that the vast majority of the observations have been performed retrospectively, resulting in errors in matching with the control groups, severely limits the reliability of the conclusions drawn. We highlighted the risks associated with various types of bariatric surgery, stressing the optimization of the screening procedures for nutritional deficiencies and counseling on correct weight gain and nutrition for a successful pregnancy. This aim needs to be achieved with the collaboration of a multidisciplinary team of specialists that work before, during and after delivery.