Intrauterine growth retardation after laparoscopic Roux-en-Y gastric bypass - clinical presentation and literature review

Abstract

Bariatric surgery is associated with a higher risk of intrauterine growth retardation (IUGR) and small for gestational age neonates. We present two examples of IUGR after laparoscopic Roux-en-Y gastric bypass, both associated with excessive restriction in patients caloric intake, one due to obstetrician's indications and the other resulting from patient's anxiety of weight gain in pregnancy. IUGR was observed accordingly in the 35th and 28th week of pregnancy. The first patient had an urgent cesarean section due to pathological cardiotocography tracings in the 35th week of pregnancy, with the newborn's weight of 1690 g (< 1st percentile). The second patient, admitted in the 28th week with suspected IUGR, had an elective cesarean section in the 36th week, with the newborn's weight of 2095 g (5th percentile). Although malabsorptive mechanisms are known to be involved in the impaired fetal growth after bariatric surgery, patients' and obstetricians' adherence to nutrition and supplementation regimen are of utmost importance. The problem of optimum daily caloric intake, vitamin and micronutrients supplementation in pregnancies after bariatric surgery is presently discussed in the literature. Optimum care and advice for bariatric patients have to be diversified as malabsorptive and restrictive operations lead to changes in metabolism, nutrition and hormonal balance.

Keywords: avitaminosis; bariatric surgery; fetal growth retardation.