Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 1/2018

01-01-2018 | Original Contributions

Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group

Authors: Sabrina Pereira da Cruz, Andréa Matos, Silvia Pereira, Carlos Saboya, Suelem Pereira da Cruz, Andréa Ramalho

Published in: Obesity Surgery | Issue 1/2018

Login to get access

Abstract

Objective

The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health.

Methodology

A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or over 1 year (T2), during a maximum of 2 years. Serum concentrations of retinol and β-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p < 0.05).

Results

RYGB reduced the serum levels of retinol and β-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and β-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of β-carotene.

Conclusion

Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.
Literature
1.
Asheim ET, Hofso D, Hjelmesaeth J, et al. Vitamin status in morbidly obese patients: a cross sectional study. Am J Clin Nutr. 2008;87(2):362–9.
2.
3.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed
4.
Facchiano E, Jannelli A, Santuli P, et al. Pregnancy after laparoscopic bariatric surgery: comparative study of adjustable gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;8(4):429–33.CrossRefPubMed
5.
Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2009;17(1):S1–S70.CrossRef
6.
Saunders C, Leal MC, Neves PA, et al. Determinants of gestational night blindness in pregnant women from Rio de Janeiro, Brazil. Public Health Nutr. 2015;19(5):851–60.CrossRefPubMed
7.
Institute of Medicine (IOM). Weight gain during pregnancy: reexamining the guidelines. Washington: National Academy Press; 2009.
8.
World Health Organization. Obesity: preventing and managing the global epidemic. Report of WHO consultation on obesity. Geneva: WHO; 1998.
9.
Rocha Q, Mendonça S, Fortes R. Perda Ponderal após Gastroplastia em Y de Roux e Importância do Acompanhamento Nutricional – Uma revisão de literatura. Ciências Saúde. 2011;22(1):61–70.
10.
Ministério da Saúde (MS). Portaria Gm/MS N. 390, Jul 6, 2005.
11.
Pedreira CE, Pinto FA, Pereira SP, et al. Birth weight patterns by gestational age in Brazil. An Acad Bras Ciênc. 2011;83(2):619–25.CrossRefPubMed
12.
Ministério da Saúde (MS). Assistência Pré-Natal. Manual Técnico. 3rd ed. Brasília: Secretaria de Políticas; 2000a.
13.
Ministério da Saúde (MS). Gestação de Alto Risco. Manual Técnico. 3rd ed. Brasília: Secretariade Políticas, Área Temática da Saúde da Mulher; 2000b.
14.
Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR 1998 47(30)
15.
Sauberlich HE, Hodges RE, Wallace DL, et al. Vitamin A metabolism and requirements in the human studied with the use of labeled retinol. Vitam Horm. 1974;32:251–75.CrossRefPubMed
16.
McLaren DS, Frigg M. Manual de ver y vivir sobre los transtornos por deficiencia de vitamina A (VADD). Washington: Organização Panamericana de Saúde; 1999.
17.
Saunders C, Leal MC, Gomes MM, et al. Gestational night blindness among women attending a public maternal hospital in Rio de Janeiro, Brazil. J Health Popul Nutr. 2004;22(4):348–56.PubMed
18.
Saunders C, Ramalho RA, Lima APPT, et al. Association between gestational night blindness and serum retinol in mother/newborn pairs in the city of Rio de Janeiro. Braz Nutr. 2005;21(4):456–61.CrossRef
19.
LoMenzo E, Cappellani A, Zanghì A, et al. Nutritional implications of obesity: before and after bariatric surgery. Bariatr Surg Pract Patient Care. 2014;9(1):9–17.CrossRef
20.
Pereira S, Saboya C, Chaves G, et al. Class III obesity and its relationship with the nutritional status of vitamin A in pre- and postoperative gastric bypass. Obes Surg. 2008;6:738–44.
21.
Yasmeen R, Jeyakumar SM, Reichert B, et al. The contribution of vitamin A to autocrine regulation of fat depots. Biochim Biophys Acta. 2011;1821(1):190–7.CrossRefPubMedPubMedCentral
22.
Osth M, Ost A, Kjolhede P, et al. The concentration of β-carotene in human adipocytes, but not the whole-body adipocyte stores, is reduced in obesity. PLoS One. 2014;9(1):1–5.CrossRef
23.
24.
25.
Clements RH, Katasani VG, Palepu R, et al. Incidence of vitamin deficiency after laparoscopic Roux-En-Y gastric bypass in a university hospital setting. Am Surg. 2006;12(72):1196–202.
26.
Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.CrossRefPubMed
27.
González I, Rubio MA, Cordido F, et al. Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obes Surg. 2015;25(3):436–42.CrossRefPubMed
28.
Topart P, Becouarn G, Sallé A, et al. Biliopancreatic diversion requires multiple vitamin and micronutrient adjustments within 2 years of surgery. ASMBS. 2014;10(5):936–41.
29.
Dadalt C, Fagundes RL, Moreira EA, et al. Oxidative stress markers in adults 2 years after Roux-en-Y gastric bypass. Eur J Gastroenterol Hepatol. 2013;25(5):580–6.CrossRefPubMed
30.
Mecocci P, Polidori MC, Troiand L, et al. Plasma antioxidants and longevity: a study on healthy centenarians. Free Radic Biol Med. 2000;28(8):1243–8.CrossRefPubMed
31.
Yang C, Chen J, Liu Z, et al. Prevalence and influence factors of vitamin A deficiency of Chinese pregnant women. Nutr J. 2015;15:12.CrossRef
32.
Sánchez-Hernández D, Anderson GH, Poon AN, et al. Maternal fat-soluble vitamins, brain development, and regulation of feeding behavior: an overview of research. Nutr Res. 2016;36(10):1045–54.CrossRefPubMed
33.
Devlieger R, Guelinckx I, Jans G, et al. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study. PLoS One. 2014;9(12):114–92.CrossRef
34.
Thorne-Lyman AL, Fawzi WW. Vitamin A and carotenoids during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. PPE. 2012;26(1):36–54.
35.
Jans G, Matthys C, Bogaerts A, et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Adv Nutr. 2015;6:420–9.CrossRefPubMedPubMedCentral
36.
Kjaer MM, Nilas L. Pregnancy after bariatric surgery: a review of benefits and risks. Acta Obstet Gynecol Scand. 2013;92(3):264–71.CrossRefPubMed
37.
Pilone V, Hasani A, Di Micco R, et al. Pregnancy after laparoscopic gastric banding: maternal and neonatal outcomes. Int J Surg. 2014;12(1):S136–9.CrossRefPubMed
38.
Yi XY, Li QF, Zhang J, et al. A meta-analysis of maternal and fetal outcomes of pregnancy after bariatric surgery. Int J Gynaecol Obstet. 2015;130(1):3–9.CrossRefPubMed
39.
Machado SN, Pereira S, Saboya C, et al. Influence of Roux-en-Y gastric bypass on the nutritional status of vitamin A in pregnant women: a comparative study. Obes Surg. 2015;26(1):26–31.CrossRef
40.
Biesalski HK, Nohr D. New aspects in vitamin A metabolism: the role of retinyl esters as systemic and local sources for retinol in mucous epithelia. J Nutr. 2004;1341(12):3453S–7S.
41.
Yilmaz A, Bahat E, Yilmaz GG, et al. Adjuvant effect of vitamin A on recurrent lower urinary tract infections. Pediatr Int. 2007;49(3):310–3.CrossRefPubMed
42.
Van Der Broek NR, White SA, Flowers C, et al. Randomized trial of vitamin A supplementation in pregnant women in rural Malawi found to be anaemic on screening by hemocue. BJOG. 2006;113(5):569–76.CrossRefPubMed
43.
Edawati DE, Jerip A, Kipli M, et al. Pregnancy and dumping syndrome post-bariatric surgery: a case report. Med J Malaysia 2017;72(2).
44.
The American Congress of Obstetricians and Gynecologists (ACOG). ACOG committee opinion number 315. Obesity in pregnancy. Obstet Gynecol. 2005;106(3):671–5.CrossRef
45.
Yermilov I, McGory ML, Shekelle PW, et al. Appropriateness criteria for bariatric surgery: beyond the NIH guidelines. Obesity. 2009;17(8):1521–7.CrossRefPubMed
46.
Parikh R, Lavoie M, Miranda L, et al. Timing of gestation after bariatric surgery: should women delay pregnancy for at least 1 postoperative year? Obstet Gynecol. 2014;123(1):165S.CrossRef
47.
Tsur A, Machtinger R, Segal-Lieberman G, et al. Obesity, bariatric surgery and future fertility. Harefuah. 2014;153(8):478–81.PubMed
48.
Pereira SE, Saboya C, Saunders C, et al. Serum levels and liver store of retinol and their association with night blindness in individuals with class III obesity. Obes Surg. 2012;22(4):602–8.CrossRefPubMed
Metadata
Title
Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group
Authors
Sabrina Pereira da Cruz
Andréa Matos
Silvia Pereira
Carlos Saboya
Suelem Pereira da Cruz
Andréa Ramalho
Publication date
01-01-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 1/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2791-6

Other articles of this Issue 1/2018

Obesity Surgery 1/2018 Go to the issue

Original Contributions

Health and Nutritional Status of Vegetarian Candidates for Bariatric Surgery and Practical Recommendations

Original Contributions

Changes in Global Transcriptional Profiling of Women Following Obesity Surgery Bypass

Brief Communication

Major Gastric Haemorrhage After Intragastric Balloon Insertion: Case Report

Original Contributions

Sleeve Gastrectomy After Liver Transplantation: Feasibility and Outcomes

Letter to the Editor

Petersen’s Hernia may be Commoner After OAGB/MGB Than Previously Reported

Original Contributions

Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Patients with Morbid Obesity and Normal Thyroid Function