Pelizzo Gloria, Calcaterra Valeria, Fusillo Mario, Nakib Ghassan, Ierullo Antonio Maria, Alfei Alessandro, Spinillo Arsenio, Stronati Mauro, Cena Hellas
Department of Maternal and Children's Health, Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo and University of Pavia, P,le Golgi 2, Pavia 27100, Italy.
Nutr J. 2014 Jun 14;13:59. doi: 10.1186/1475-2891-13-59.
Bariatric surgery results in decreased food intake and a variable degree of malabsorption. Without adequate supplementation, the most common complications of this surgery are nutritional disorders. Pregnancy following surgery for obesity is a particular condition requiring strict monitoring of nutrient intake necessary for fetal development and a favourable neonatal prognosis.
Malnutrition in pregnancy and congenital neural malformations are reported in three women who had previously undergone bariatric surgery (1, 5 and 18 years before pregnancy, respectively). Two patients underwent the Roux en Y bypass and one bilio-pancreatic diversion with gastroplasty. None of the three received pre-conceptional nutritional counselling. Patients 1 and 2 did not undergo postoperative nutritional surveillance; nutrient supplementation was started at 22 and 20 weeks gestation, respectively. In patient 3, supplementation was stopped at six weeks gestation.
Newborns 1 and 2 presented with dorsal myelomeningocele and ventricular dilation. Both underwent surgery and a ventriculo-peritoneal shunt was inserted in the first month of life. Newborn 3 had microcephaly, bilateral microphthalmia and sensorineural deafness.
Diet and nutritional status, before and during pregnancy, play an important role in the early processes of fetal development and neonatal outcome. Women of childbearing age who have had bariatric surgery, should be encouraged to follow a well-balanced diet as part of a weight management strategy. They should be advised to take recommended maternal supplements.
减肥手术会导致食物摄入量减少和不同程度的吸收不良。如果没有足够的补充，这种手术最常见的并发症是营养紊乱。肥胖手术后怀孕是一种特殊情况，需要严格监测胎儿发育所需的营养摄入以及良好的新生儿预后。
三名曾接受减肥手术的女性（分别在怀孕前1年、5年和18年）出现了孕期营养不良和先天性神经畸形。两名患者接受了Roux-en-Y胃旁路手术，一名接受了胆胰转流术加胃成形术。三人都没有接受孕前营养咨询。患者1和2术后未进行营养监测；分别在妊娠22周和20周开始补充营养。患者3在妊娠6周时停止补充营养。
新生儿1和2患有脊柱裂和脑室扩张。两人均接受了手术，并在出生后第一个月插入了脑室-腹腔分流管。新生儿3患有小头畸形、双侧小眼症和感音神经性耳聋。
孕期前后的饮食和营养状况在胎儿发育早期过程和新生儿结局中起着重要作用。接受减肥手术的育龄妇女应被鼓励遵循均衡饮食，作为体重管理策略的一部分。应建议她们服用推荐的孕期补充剂。
