PRECONCEPTION PLANNING AND ANTENATAL SURVEILLANCE AFTER GASTRIC BYPASS AND SLEEVE GASTRECTOMY
DOI:
https://doi.org/10.63330/aurumpub.068-055Keywords:
Bariatric surgery, Gastric bypass, Gastrectomy, Nutritional deficiencies, PregnancyAbstract
Pregnancy after bariatric surgery requires care tailored to digestive anatomy, weight trajectory, and nutritional and metabolic conditions. This chapter examines how to organize preconception planning and antenatal care for women who have undergone Roux-en-Y gastric bypass or sleeve gastrectomy. It is a critical narrative review based on documented PubMed/MEDLINE searches and complementary consultation of institutional sources, journals, and full-text repositories, updated through October 2026. The synthesis integrates observational studies, reviews, and clinical recommendations, distinguishing empirical evidence from consensus. Surgery is associated with lower risks of some obesity-related complications, but also with greater vulnerability to nutritional deficiencies, impaired fetal growth, and, after bypass, internal herniation. Weight stability and correction of deficiencies provide more informative criteria for pregnancy planning than an isolated chronological interval. The oral glucose tolerance test has safety and interpretation limitations, requiring alternative strategies that remain incompletely validated. Three tables integrate differences between procedures, nutritional surveillance, and care by pregnancy stage. Individual assessment, longitudinal monitoring, and prompt responses to warning symptoms are essential, and metabolic benefits should not be interpreted as elimination of obstetric risk.
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AKHTER, Zainab et al. Pregnancy after bariatric surgery and adverse perinatal outcomes: A systematic review and meta-analysis. PLOS Medicine, v. 16, n. 8, art. e1002866, 2019. DOI: 10.1371/journal.pmed.1002866. Disponível em: https://doi.org/10.1371/journal.pmed.1002866. Acesso em: 4 out. 2026.
AMERICAN DIABETES ASSOCIATION PROFESSIONAL PRACTICE COMMITTEE FOR DIABETES. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2026. Diabetes Care, v. 49, n. Suppl 1, p. S321-S338, 2026. DOI: 10.2337/dc26-S015. Disponível em: https://doi.org/10.2337/dc26-S015. Acesso em: 4 out. 2026.
BENHALIMA, Katrien et al. Screening and Management of Gestational Diabetes Mellitus after Bariatric Surgery. Nutrients, v. 10, n. 10, art. 1479, 2018. DOI: 10.3390/nu10101479. Disponível em: https://doi.org/10.3390/nu10101479. Acesso em: 4 out. 2026.
BRASIL. Ministério da Saúde. Manual de gestação de alto risco. Brasília, DF: Ministério da Saúde, 2022. Cap. 55: Gestação pós-cirurgia bariátrica, p. 551–558. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/manual_gestacao_alto_risco.pdf. Acesso em: 4 out. 2026.
BURLINA, Silvia; DALFRÀ, Maria Grazia; LAPOLLA, Annunziata. Pregnancy after Bariatric Surgery: Nutrition Recommendations and Glucose Homeostasis: A Point of View on Unresolved Questions. Nutrients, v. 15, n. 5, art. 1244, 2023. DOI: 10.3390/nu15051244. Disponível em: https://doi.org/10.3390/nu15051244. Acesso em: 4 out. 2026.
CHEN, Wenhui et al. Early Pregnancy (≤ 12 Months) After Bariatric Surgery: Does It Really Influence Maternal and Perinatal Outcomes? Obesity Surgery, v. 32, n. 4, p. 979-990, 2022. DOI: 10.1007/s11695-021-05800-4. Disponível em: https://doi.org/10.1007/s11695-021-05800-4. Acesso em: 4 out. 2026.
DE SIMONE, Belinda et al. Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines. World Journal of Emergency Surgery, v. 17, n. 1, art. 51, 2022. DOI: 10.1186/s13017-022-00452-w. Disponível em: https://doi.org/10.1186/s13017-022-00452-w. Acesso em: 4 out. 2026.
GUTHRIE, Taylor M et al. A Systematic Review Investigating Maternal Nutrition During Pregnancy After Bariatric Surgery. Obesity Surgery, v. 33, n. 6, p. 1857-1865, 2023. DOI: 10.1007/s11695-023-06565-8. Disponível em: https://doi.org/10.1007/s11695-023-06565-8. Acesso em: 4 out. 2026.
GUTHRIE, Taylor et al. Micronutrient Deficiency During Pregnancy After Bariatric Surgery: The Role of Micronutrient Supplements and Dietary Intake. Obesity Surgery, v. 36, n. 5, p. 2191-2203, 2026. DOI: 10.1007/s11695-026-08576-7. Disponível em: https://doi.org/10.1007/s11695-026-08576-7. Acesso em: 4 out. 2026.
HAZLEHURST, Jonathan et al. Society for Endocrinology guidelines for the diagnosis and management of post-bariatric hypoglycaemia. Endocrine Connections, v. 13, n. 5, art. e230285, 2024. DOI: 10.1530/EC-23-0285. Disponível em: https://doi.org/10.1530/EC-23-0285. Acesso em: 4 out. 2026.
HEUSSCHEN, Laura et al. A Matter of Timing-Pregnancy After Bariatric Surgery. Obesity Surgery, v. 31, n. 5, p. 2072-2079, 2021. DOI: 10.1007/s11695-020-05219-3. Disponível em: https://doi.org/10.1007/s11695-020-05219-3. Acesso em: 4 out. 2026.
HUANG, Bonnie et al. Micronutrient screening, monitoring, and supplementation in pregnancy after bariatric surgery. Obstetric Medicine, v. 15, n. 3, p. 151-159, 2022. DOI: 10.1177/1753495X211013624. Disponível em: https://doi.org/10.1177/1753495X211013624. Acesso em: 4 out. 2026.
JOHANSSON, Kari et al. Outcomes of pregnancy after bariatric surgery. The New England Journal of Medicine, v. 372, n. 9, p. 814-824, 2015. DOI: 10.1056/NEJMoa1405789. Disponível em: https://doi.org/10.1056/NEJMoa1405789. Acesso em: 4 out. 2026.
JOLY, Marie-Anne et al. Comparison of pregnancy outcomes after bariatric surgery by sleeve gastrectomy versus gastric bypass. European Journal of Obstetrics & Gynecology and Reproductive Biology X, v. 22, art. 100309, 2024. DOI: 10.1016/j.eurox.2024.100309. Disponível em: https://doi.org/10.1016/j.eurox.2024.100309. Acesso em: 4 out. 2026.
MORGAN, Harriet D et al. The approach to a pregnancy after bariatric surgery. Clinical Medicine, v. 25, n. 1, art. 100275, 2025. DOI: 10.1016/j.clinme.2024.100275. Disponível em: https://doi.org/10.1016/j.clinme.2024.100275. Acesso em: 4 out. 2026.
MUSTAFA, Hiba J et al. Prepregnancy Roux-en-Y gastric bypass vs sleeve gastrectomy: a systematic review, pairwise, and network meta-analysis of obstetrical and neonatal outcomes. American Journal of Obstetrics & Gynecology MFM, v. 5, n. 6, art. 100914, 2023. DOI: 10.1016/j.ajogmf.2023.100914. Disponível em: https://doi.org/10.1016/j.ajogmf.2023.100914. Acesso em: 4 out. 2026.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE). Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years. NICE guideline NG247. London: NICE, 2025. Disponível em: https://www.nice.org.uk/guidance/ng247/chapter/Recommendations. Acesso em: 4 out. 2026.
O'KANE, Mary et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obesity Reviews, v. 21, n. 11, art. e13087, 2020. DOI: 10.1111/obr.13087. Disponível em: https://doi.org/10.1111/obr.13087. Acesso em: 4 out. 2026.
SHAWE, Jill et al. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care. Obesity Reviews, v. 20, n. 11, p. 1507-1522, 2019. DOI: 10.1111/obr.12927. Disponível em: https://doi.org/10.1111/obr.12927. Acesso em: 4 out. 2026.
STENTEBJERG, Louise L et al. Roux-en-Y Gastric Bypass Increases Glycemic Excursions During Pregnancy and Postpartum: A Prospective Cohort Study. Diabetes Care, v. 46, n. 3, p. 502-510, 2023. DOI: 10.2337/dc22-1357. Disponível em: https://doi.org/10.2337/dc22-1357. Acesso em: 4 out. 2026.
STENTEBJERG, Louise Laage et al. Altered postprandial glucose metabolism and enteropancreatic hormone responses during pregnancy following Roux-en-Y gastric bypass: a prospective cohort study. BMJ Open Diabetes Research & Care, v. 13, n. 2, art. e004672, 2025. DOI: 10.1136/bmjdrc-2024-004672. Disponível em: https://doi.org/10.1136/bmjdrc-2024-004672. Acesso em: 4 out. 2026.
VANNEVEL, Valerie et al. Internal Herniation in Pregnancy After Gastric Bypass: A Systematic Review. Obstetrics & Gynecology, v. 127, n. 6, p. 1013-1020, 2016. DOI: 10.1097/AOG.0000000000001429. Disponível em: https://doi.org/10.1097/AOG.0000000000001429. Acesso em: 4 out. 2026.
ZAJDENVERG, Lenita et al. Rastreamento e diagnóstico da hiperglicemia na gestação. In: SOCIEDADE BRASILEIRA DE DIABETES. Diretriz Oficial da Sociedade Brasileira de Diabetes. [S. l.]: SBD, 2023. DOI: 10.29327/557753.2022-11. Disponível em: https://diretriz.diabetes.org.br/rastreamento-e-diagnostico-da-hiperglicemia-na-gestacao/. Acesso em: 4 out. 2026.
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