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Bypass and babies

Gastric bypass linked with low birth weight babies

Women who undergo gastric bypass surgery for weight loss risk giving birth to babies that are small or have lower average birth weights

Women who undergo gastric bypass surgery for weight loss risk giving birth to babies that are small or have lower average birth weights, according to a presentation at the 55th Annual European Society for Paediatric Endocrinology Meeting, in Paris, France. The findings could lead to different advice and clinical care for pregnant women who have undergone gastric bypass surgery.

Women treated with gastric bypass surgery are advised to wait 18 months after the procedure before trying to become pregnant in order to establish a stable, healthy weight. They must also follow a daily multivitamin supplementation regime and receive regular clinical follow up before, during and after the pregnancy.

In their research, ‘Higher Risk of Low Birth Weight and Multiple Nutritional Deficiencies in Neonates from Mothers after Gastric Bypass: A Case Control Study’, the team from the Department of Paediatrics, University Hospital, Angers, France, compared the clinical and cord blood biological characteristics of 56 newborns of gastric bypass mothers and 56 newborns of healthy mothers, in the Obstetrics Department of Angers University Hospital between March 2008 and October 2012. After bypass, the women took multivitamin and trace element supplements. They had blood drawn at delivery for nutritional assessment.

The reported that birth weight was 0.34kg lower in neonates born to bypass mothers (p<0.01), and 23% were small for gestational age vs. 3.6% in control group (odds ratio 8.2, 95% CI 1.7–38.1, p<0.01). Cord blood mean concentrations were significantly lower for Ca, zinc, and vitamin A (p<0.05). OR for cord blood concentrations below the 2.5th percentile were significant in bypass neonates for calcium [4.3 (1.3;14.1)], zinc and iron [3.8 (1.0; 14.8)], and vitamin A [OR 3.5 (1.1;11.8)].

In contrast, the OR for cord blood concentrations over the 97.5th percentile were significant in bypass neonates for Mg [OR 4.3 (1.1;16.4)] and vitamin E [OR 4.6 (1.2;17.3)], owing to maternal supplementation. Birth weight was related to variation in BMI between surgery and pregnancy (r=0.45, p<0.01) and unrelated to time between surgery and pregnancy, BMI at pregnancy onset and weight gain during pregnancy.

A significantly higher percentage of bypass mothers than expected displayed concentrations <2.5th percentile for calcium (13%), phosphorus (18%), zinc (21%), vitamin A (18%), and IGF-1 (28%) (P<0.05).

"Maternal obesity can lead to health conditions for the newborn, such as high birth weight and low blood sugar. It can also cause birthing complications, and gastric bypass can prevent these," said Dr Maxime Gerard, lead researcher of the study. "But our study showed that gastric bypass could have other effects on newborns."

They team saw that, despite supplementation, a proportion of gastric bypass mothers were deficient in key nutrients during pregnancy, such as calcium and zinc. Analysis of the newborns showed that they also suffered lower than average levels of the same nutrients.

"These maternal nutrient deficiencies may be the reason for the same deficiencies and low birth weights seen in the newborns," she added. "One of our next steps will be to confirm this and determine its impact."

The researchers added that these are only preliminary findings and as the study continues the team's next key step is to determine if low birth weights have long term consequences for the children in the study. They would also like to establish optimal nutritional supplementation for mothers who have undergone gastric bypass surgery, to ensure they do not suffer from nutritional deficiencies during pregnancy.

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