Reproductive Concerns and Pregnancy after Bariatric Surgery: Practice Implications

Abstract

Approximately 113,000 bariatric procedures are conducted yearly. From 1998 to 2005, 83% of those having bariatric surgery in the 18 to 45-year-old age group were women. Reproductive implications are ideally addressed when surgery is planned, including the possibility of increased fertility after surgery, appropriate contraception, and the interval from surgery to pregnancy. Maternal and neonatal outcomes post bariatric surgery have generally been found to be positive and are often improved over those seen in obese women without a history of bariatric procedures. However, surgical complications have been reported, as well as nutritional deficits. Some studies have suggested an increase in small for gestational age (SGA) newborns and increased cesarean section rates, while others have not found these relationships. Neonatal complications have also been reported. Pregnancy care for women with a history of bariatric surgery includes screening for and managing nutritional deficits, careful assessment to rule out surgical complications, and attention to psychosocial needs. The aim of this article is to review findings of studies that examined the impact of bariatric procedures on fertility, contraception, pregnancy, and maternal and neonatal outcomes. In addition, the resulting implications for practice for all members of the healthcare team caring for women with a history of bariatric surgery, who are or may become pregnant, will be discussed.