Pregnancy and Fertility Following Bariatric Surgery
In the last three years, more than 150,000 women of child-bearing age underwent bariatric surgery to address their obesity, and this figure is likely an underestimate. However, ways in which these procedures—and their accompanying weight loss and changes to the body's nutritional mechanisms—may affect fertility are poorly understood. The authors conducted a literature review to assess associations of bariatric surgery on pregnancy outcomes, including maternal and neonatal outcomes, adverse nutritional events, fertility and others. After exclusions, 75 articles published between 1985-2008 were included in the review.
The conclusions available from this review were limited by the quality of the studies, as many of the studies suffered from selection bias and small sample size. Some conclusions the authors drew from available evidence, however, included that maternal complications during pregnancy may be less likely following bariatric surgery than complications in obese women; neonatal complications may also be lower in pregnancies following bariatric surgery; and nutritional complications seem uncommon and may be largely due to patients' failure to adhere to supplement regimens. The authors were not able to make conclusions about the effects of bariatric surgery on fertility, though there was some evidence that sex hormones may normalize post-surgery, and improvements in polycystic ovary disease and menstrual irregularities may also occur. Complications from surgery did not often manifest during pregnancy, but the most commonly reported complication was internal hernia resulting in injury to bowels. Further research, including randomized clinical trials, is needed in order to better grasp the effects of these surgeries on maternal and neonatal health.