Purpose: Evaluation of obstetric and neonatal outcomes in a Brazilian retrospective cohort of pregnancies after Roux-en-Y gastric bypass (RYGB), regarding the 2009 Institute of Medicine (IOM) recommendations about gestational weight gain (GWG) and RYGB-conception interval. Additionally, search for intrapopulation risk factors for small gestational age (SGA) offspring and mental health assessments.
Material and methods: Retrospective analysis of 132 singleton pregnancies after RYGB. Obstetric and neonatal outcomes were analyzed with stratification in above, below, or meeting the target regarding GWG guidance, and 0-12, 12-47, and ≥48 months for RYGB-conception interval. SGA risk factors were identified through Poisson regression analysis.
Results: GWG below the recommendations was associated with prematurity (p 0.003). Late conceptions (≥48 months) were associated with iron deficiency (p 0.025). Parenteral iron prescription was a protective factor for SGA, with a relative risk of 0.41 (95% CI, 0.20-0.85; p 0.017), and GWG below target was a SGA risk factor, with a relative risk of 4.68 (95% CI, 1.48-14.8; p 0.008). In all, 15.2% of patients had psychopharmacological treatment during pregnancy, and 7.6% received a diagnosis of postpartum depression. Any alcohol and tobacco consumption were reported in 3.8 and 6.8% of patients, respectively.
Conclusion: The recommendations regarding GWG apply to the RYGB population, and surgery-conception intervals should be individualized. The parenteral iron prescription was a protective factor for SGA, and GWG below the recommendations of the IOM was a risk factor for SGA. Psychological and psychiatric care should be offered to every possible pregnancy after RYGB.
Keywords: Bariatric surgery; Gestational weight gain; Mental health; Obesity; Pregnancy.