Article

The surgical management of obesity in young women: consideration of the mother's and baby's health before, during, and after pregnancy

Department of Surgery, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields, Tyne & Wear NE29 8NH, England, UK.
Surgical Endoscopy (Impact Factor: 3.31). 08/2008; 22(10):2107-16. DOI: 10.1007/s00464-008-0019-5
Source: PubMed

ABSTRACT Maternal obesity has a substantial associated morbidity and mortality affecting both mother and child. This has a major impact on provision of care due to increased requirements for both medical and surgical management of the consequences that follow obesity in pregnancy.
A review examined the English language literature on Medline databases describing the effect of obesity on pregnancy and outcomes of pregnancy after bariatric surgery. Guidelines from the National Institute for Clinical Excellence yielded information on selection criteria for fertility treatment and bariatric surgery. The World Health Organization definitions of overweight and obesity were adhered to throughout this review.
The level of clinical and morbid obesity has shown a dramatic increase in women of childbearing age, with far-reaching consequences for both their own health and that of their offspring. Obese women require a substantial amount of additional clinical care beyond that offered to women of normal weight due to the wide range of medical and obstetric complications they experience. Recent evidence suggests that obesity may be implicated in approximately one-third of maternal deaths. The consensus of the literature is that the best way to reduce obesity-associated morbidity is by weight reduction before pregnancy. Where behavioral and medical interventions fail, the most successful method is bariatric surgery. The effect of surgery on the outcome of subsequent pregnancies indicate improved chances of normal pregnancy, delivery, and healthy babies.
Bariatric surgery is a safe and effective method of weight loss for morbidly obese women of childbearing age, with favorable outcomes for pregnancies after surgery.

4 Followers
 · 
108 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Le nombre de femmes jeunes opérées d’obésité morbide (OM) ne cesse de croître en France. Toutes sont susceptibles d’avoir des enfants. Le but de cet article était de décrire à partir d’une revue de la littérature les étapes de prise en charge d’une femme enceinte opérée d’OM et la prévention des complications foeto-maternelles. Il existe encore de nombreuses controverses et les connaissances restent partielles. Un chirurgien viscéral impliqué dans la chirurgie bariatrique se doit de connaître ce sujet. Son action de surveillance devra être intégrée à chaque étape avec un gynécologue obstétricien et la patiente.
    Obésité 09/2012; 7(3). DOI:10.1007/s11690-012-0339-4
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this systematic review was to determine the current state of knowledge about intrapartum management associated with obesity in healthy nulliparous women. Nulliparous obese women are at higher risk for unplanned cesarean birth when compared with their normal-weight counterparts, and much of this increased risk is associated with labor management differences. There is a need to better understand the differences in intrapartum management of nulliparous women who are obese. The PubMed, CINAHL, EBSCO, Google Scholar, and MEDLINE databases were searched in August 2012, with identified studies then assessed for applicability and quality. Eight studies were retained for the review. Intrapartum interventions used significantly more often for healthy, obese nulliparous women when compared with normal-weight women were induction of labor, augmentation of labor, and cesarean birth. It is unclear if assisted vaginal birth occurs more frequently among obese women. Epidural anesthesia, artificial rupture of membranes prior to 6 cm of cervical dilation, and early hospital admission were shown in separate studies to be used more often in obese women. Intrapartum interventions were used more frequently in obese women in a dose-dependent manner by body mass index. Future studies examining the intrapartum management of obese nulliparous women are needed with: 1) samples defined by standardized obesity classifications; 2) further analysis of diverse intrapartum interventions; and 3) prospective, randomized designs to allow for causality conclusions linking intrapartum intervention use to an obese woman's risk for cesarean birth. Implications for clinical practice from this systematic review are that healthy, nulliparous obese women are exposed to common intrapartum interventions more often than normal-weight women. In the absence of evidence on the use of appropriate use of intrapartum interventions in this population, health care providers should carefully monitor management choices when working with healthy, nulliparous obese women.
    Journal of midwifery & women's health 01/2014; 59(1). DOI:10.1111/jmwh.12073 · 1.04 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesity poses a significant risk to reproductive-aged women. Weight reduction before conception is the best way to increasing fertility and reduces obesity associated morbidity. When medical interventions fail, bariatric surgery is the most successful method of weight loss, effective increasing fertility and reducing obstetrical complications and maternal and neonatal morbidity comparing obese women. Gastric banding and gastric bypass are the most increasingly utilized treatment option in France and should be offered to morbidly obese women of childbearing age. This literature review provides information about different techniques of bariatric surgery and about the multidisciplinary management of these pregnancies (monitoring, micronutrient supplementation) to promote maternal and fetal wellbeing in concert with continuing postoperative weight control.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 04/2009; 38(2):107-116. DOI:10.1016/j.jgyn.2008.12.002 · 0.62 Impact Factor

Full-text

Download
74 Downloads
Available from
May 22, 2014