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The prevalence of obesity in New Zealand is increasing with 1 in every 5 adults being obese.1 It is well documented that pregnancy in obese women is associated with an increased risk of many adverse events and outcomes. These include such things as pre-eclampsia, the need for induction of labour, caesarian section, post-partum haemorrhage, and large for gestational age (LGA) deliveries.2 In addition, severely obese women are at increased risk of gestational diabetes and their babies of congenital birth defects, neonatal hypoglycaemia, jaundice, and the need for admission to neonatal intensive care.3
Severely obese mothers are at increased risk of thromboembolism, anaesthetic complications, and wound infections following caesarean section.4 Similar adverse neonatal and perinatal outcomes have been reported for overweight adolescent women.5
Bariatric surgery has emerged in the last 10-15 years as an effective and reliable solution to severe obesity6 and more and more severely obese individuals are choosing this option for managing their problem. Although a number of previous reports have addressed the course and outcome of pregnancy in women who have undergone bariatric surgery7-12 such information remains poorly disseminated.
At a time when most health professionals have little personal knowledge or experience of bariatric surgery, many remain uncertain about the expected course of pregnancy and delivery for mothers who have had bariatric surgery. This report documents the outcomes of 24 pregnancies in 17 women following gastric bypass surgery for severe obesity.
Methods
This study was undertaken on women who had undergone gastric bypass surgery at Wakefield Hospital, Wellington. All surgeries were performed by the senior author (RSS) who has performed over 1100 gastric bypass operations since 1986. See Figure 1.
Figure 1. A schematic representation of the gastric bypass operation
[Image omitted. See PDF]
A full description of the operation and its outcomes is available elsewhere.13 In brief, the stomach is divided into two component parts. A small 5-10 ml gastric pouch extending from the oesophago-gastric junction down the lesser curve of the stomach and a large distal component of the stomach, which together with the duodenum and initial 50-70 cm of jejunum is excluded from the food stream.
A 70 cm Roux loop of jejunum is created and joined to the small gastric pouch, which means ingested food enters directly into the...