Weight loss or bariatric surgery is often the last resource for obese or morbidly obese patients who have tried but failed to lose weight with other types of medically supervised weight loss programs. Losing weight alone is not an easy task and many patients are recommended one of the different types of bariatric surgery performed in the Unites States, which includes gastric bypass, sleeve gastrectomy, adjustable gastric band (gastric banding), and biliopancreatic diversion with duodenal switch. This last procedure is the least common of the surgical procedures, but it is particularly effective in helping patients achieve and maintain excessive weight loss.
Biliopancreatic diversion with duodenal switch (BPD/DS) consists of the removal of a specific part of the stomach and reconnection of the organ to the small intestine, which results in an alteration of the normal digestive process, as the stomach will hold less amounts of food, the food will bypass part of the intestine, and the intestine will absorb fewer calories. Undergoing bariatric surgery impacts all aspects of a patient’s life, including future pregnancies. Therefore, it is important for patients to understand the positive and negative repercussions.
Benefits of a Biliopancreatic Diversion with Duodenal Switch in Future Pregnancies
Undergoing biliopancreatic diversion provokes not only weight loss, but also improvements in patients’ overall health, which is also important when women get pregnant or plan to. The study “Outcome of pregnancies after biliopancreatic diversion” demonstrates that while severe obesity has harmful effects on fertility and pregnancy outcomes, the surgery can reduce the risks. 47.0% of patients unable to conceive before the surgery were successful after. Similarly, the incidence of fetal macrosomia decreased from 34.8 to 7.7%, and normal-weight babies increased from 62.1 to 82.7%.
“Major weight loss following BPD improves the reproductive function of severely obese women. BPD provides major beneficial effects for both mother and child, including normalization of gestational weight changes, reduction of fetal macrosomia, and normalization of the infant’s birth-weight. Our results speak in favor of delaying pregnancy in obese women until after the substantial surgical weight loss has occurred,” concluded the authors. In addition, mothers submitted to bariatric surgery also have lower risk of maternal complications including preeclampsia and gestational diabetes compared with obese controls or pre-surgery pregnancies.
Potential Problems of Getting Pregnant After a Biliopancreatic Diversion with Duodenal Switch
Despite the positive results for both mothers and babies, there are also negative effects of undergoing a biliopancreatic diversion with duodenal switch. Due to a reducion in nutrient availability, there is an increased risk for mothers who were submitted to the surgery to suffer from gestational undernutrition, which is harmful for both the baby and the mother. In addition, the rate of premature delivery does not seem to significantly differ in pregnancies after bariatric surgery, but the rate of miscarriage is elevated in obese women and seem to persist on 26.0% among women submitted to the surgery, according to the study “Pregnancy after Bariatric Surgery: A Review.”
“Comparing all pregnancies of patients with and without previous bariatric surgery, the perinatal mortality rate was not significantly different between the groups. However, a number of observational studies have highlighted the importance of further research into the potential increase in congenital malformations following bariatric surgery; a prospective cohort of 239 pregnancies after BPD reported two birth malformations, one infant dying from surgery for meconium obstruction and two deaths from ‘unknown causes,'” concluded the researchers.