Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
Eur J Clin Nutr. 2018 Aug;72(8):1176-1179. doi: 10.1038/s41430-018-0224-9. Epub 2018 Jun 12.
Adequate vitamin A is essential for healthy pregnancy, but high levels may be teratogenic. We present a patient who underwent bariatric surgery, prior to child bearing, and suffered maternal and foetal complications during eleven pregnancies, possibly associated with vitamin A deficiency, amongst multiple micronutrient deficiencies and risk factors including smoking and obesity. Maternal complications included visual disturbance, night blindness and recurrent infections. Recurrent foetal pulmonary hypoplasia and microphthalmia led to foetal and neonatal loss, not previously described in the medical literature. Current guidance on vitamin A deficiency in pregnancy is focused on developing countries where aetiology of vitamin A deficiency is different to that of women in developed countries. We describe nutritional management of the micronutritient deficiencies, focusing on vitamin A, during her last pregnancy. The need for specific antenatal nutritional guidance for pregnant women post-bariatric surgery is becoming more urgent as more mothers and offspring will be affected.
足够的维生素 A 对健康妊娠至关重要，但高水平的维生素 A 可能具有致畸性。我们介绍了一位患者，她在生育前接受了减重手术，并在十一次妊娠中经历了母亲和胎儿的并发症，这可能与维生素 A 缺乏以及多种微量营养素缺乏和危险因素有关，包括吸烟和肥胖。母亲的并发症包括视力障碍、夜盲症和反复感染。反复发生的胎儿肺发育不全和小眼症导致胎儿和新生儿死亡，这在医学文献中尚未有过描述。目前关于妊娠维生素 A 缺乏的指南主要集中在发展中国家，那里维生素 A 缺乏的病因与发达国家的妇女不同。我们描述了在她最后一次妊娠期间对微量营养素缺乏症（重点是维生素 A）的营养管理。随着越来越多的母亲和后代受到影响，对接受过减重手术的孕妇进行特定的产前营养指导的需求变得更加迫切。
