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DOI: 10.1055/s-0030-1248560
© Georg Thieme Verlag KG Stuttgart · New York
Fertilität und Schwangerschaft nach bariatrischer Chirurgie zur Behandlung der hochgradigen Adipositas
Fertility and Pregnancy After Bariatric Surgery for the Treatment of Severe ObesityPublikationsverlauf
Publikationsdatum:
07. September 2010 (online)
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Zusammenfassung
Bariatrische Operationen werden immer häufiger zur Behandlung der ausgeprägten Adipositas durchgeführt. Viele der operierten Frauen befinden sich in einem fertilen Alter, wobei die hochgradige Adipositas nicht selten mit Fertilitätsstörungen verbunden ist. Der chirurgisch induzierte Gewichtsverlust führt oft zu einer deutlichen Verbesserung der Fertilität, was wahrscheinlich auf eine Reduktion zirkulierender männlicher Sexualhormone zurückzuführen ist. Obgleich die Datenlage zu Schwangerschaftsverläufen nach bariatrischen Operationen noch recht dünn ist, scheint insgesamt die Häufigkeit von Schwangerschaftskomplikationen im Vergleich zu nicht operierten adipösen Frauen reduziert zu sein. Es sind jedoch auch einzelne Fälle von schwerwiegenden Komplikationen aufgrund von nutritiven Mangelzuständen in der Literatur berichtet worden. Insbesondere während einer Schwangerschaft ist daher nach bariatrischen Operationen immer eine ausreichende Nährstoffversorgung sicherzustellen. Hierzu ist meist der systematische Einsatz von Mikronährstoffsupplementen notwendig. In diesem Übersichtsartikel sollen einige ernährungsmedizinisch relevante Aspekte zum Thema Fertilität und Schwangerschaft nach bariatrischer Chirurgie zusammenfassend dargestellt werden.
Abstract
Bariatric surgery is increasingly performed for the treatment of severe obesity. Many women who undergo a bariatric operation are in a fertile age, while severe obesity per se is not seldom associated with impaired fertility. Surgical-induced marked weight loss frequently leads to an improvement of fertility which may result from a reduction of circulating androgen levels. While data on pregnancy courses after bariatric surgery are still scare, overall the frequency of pregnancy-associated complications seems to be reduced when compared with non-operated obese women. However, several cases of fetal complications resulting from severe nutritional deficiencies have been reported. In light of these reports the need of sufficient nutritional supply after bariatric surgery, in particular during pregnancy, has to be emphasized. To achieve this goal the intake of several supplements is frequently required. Here we provide an overview on nutritional aspects regarding the issue of fertility and pregnancy after bariatric surgery.
Schlüsselwörter
hochgradige Adipositas - bariatrische Chirurgie - Magenbypass - biliopankreatische Diversion - Magenband - Schwangerschaft - Fertilität - Mikronährstoffsupplementation
Keywords
severe obesity - bariatric surgery - gastric bypass - biliopancreatic diversion - gastric banding - pregnancy - fertility - micronutrient supplementation
Literatur
- 1 Buchwald H, Williams S E. Bariatric Surgery Worldwide 2003. Obes Surg. 2004; 14 1157-1164
- 2 Sturm R. Increases in morbid obesity in the USA: 2000–2005. Public Health. 2007; 121 492-496
- 3 Adams T D, Gress R E, Smith S C. et al . Long-term mortality after gastric bypass surgery. N Engl J Med. 2007; 357 753-761
- 4 Sjostrom L, Narbro K, Sjostrom C D. et al . Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007; 357 741-752
- 5 Buchwald H, Avidor Y, Braunwald E. et al . Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004; 292 1724-1737
- 6 Mahony D. Psychological gender differences in bariatric surgery candidates. Obes Surg. 2008; 18 607-610
- 7 Practice commitee of american society for reproductive medicine . Obesity and reproduction: an educational bulletin. Fertil Steril. 2008; 90 S21-S29
- 8 Gambineri A, Pelusi C, Vicennati V. et al . Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord. 2002; 26 883-896
- 9 Norman R J, Dewailly D, Legro R S. et al . Polycystic ovary syndrome. Lancet. 2007; 370 685-697
- 10 Samojlik E, Kirschner M A, Silber D. et al . Elevated production and metabolic clearance rates of androgens in morbidly obese women. J Clin Endocrinol Metab. 1984; 59 949-954
- 11 Gambineri A, Pelusi C, Manicardi E. et al . Glucose intolerance in a large cohort of mediterranean women with polycystic ovary syndrome: phenotype and associated factors. Diabetes. 2004; 53 2353-2358
- 12 Kupelian V, Page S T, Araujo A B. et al . Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab. 2006; 91 843-850
- 13 Bühling K. Gynäkologische und geburtshilfliche Komplikationen bei Frauen mit Adipositas. Aktuel Ernahrungsmed. 2009; 34 126-130
- 14 Catalano P M. Management of obesity in pregnancy. Obstet Gynecol. 2007; 109 419-433
- 15 Stothard K J, Tennant P W, Bell R. et al . Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA. 2009; 301 636-650
- 16 Fried M, Hainer V, Basdevant A. et al . Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (Lond). 2007; 31 569-577
- 17 Hauner H, Buchholz G, Hamann A. et al .Prävention und Therapie der Adipositas. Deutsche Adipositas Gesellschaft, Deutsche Diabetes-Gesellschaft, Deutsche Gesellschaft für Ernährung, Deutsche Gesellschaft für Ernährungsmedizin (Hrsg.). 2005
- 18 Ernst B, Thurnheer M, Wilms B. et al . Differential changes in dietary habits after gastric bypass versus gastric banding operations. Obes Surg. 2009; 19 274-280
- 19 Malinowski S S. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006; 331 219-225
- 20 Bloomberg R D, Fleishman A, Nalle J E. et al . Nutritional deficiencies following bariatric surgery: what have we learned?. Obes Surg. 2005; 15 145-154
- 21 Gong K, Gagner M, Pomp A. et al . Micronutrient deficiencies after laparoscopic gastric bypass: recommendations. Obes Surg. 2008; 18 1062-1066
- 22 Winckler K. Ernährungsmedizinische Nachsorge nach Adipositaschirurgie. Aktuel Ernahrungsmed. 2009; 34 33-37
- 23 Bilenka B, Ben-Shlomo I, Cozacov C. et al . Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity. Acta Obstet Gynecol Scand. 1995; 74 42-44
- 24 Deitel M, Stone E, Kassam H A. et al . Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988; 7 147-153
- 25 Marceau P, Kaufman D, Biron S. et al . Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004; 14 318-324
- 26 Eid G M, Cottam D R, Velcu L M. et al . Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005; 1 77-80
- 27 Teitelman M, Grotegut C A, Williams N N. et al . The impact of bariatric surgery on menstrual patterns. Obes Surg. 2006; 16 1457-1463
- 28 Escobar-Morreale H F, Botella-Carretero J I, Varez-Blasco F. et al . The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005; 90 6364-6369
- 29 Gerrits E G, Ceulemans R, Van H R. et al . Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg. 2003; 13 378-382
- 30 Mari A, Manco M, Guidone C. et al . Restoration of normal glucose tolerance in severely obese patients after bilio-pancreatic diversion: role of insulin sensitivity and beta cell function. Diabetologia. 2006; 49 2136-2143
- 31 Maggard M A, Yermilov I, Li Z. et al . Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008; 300 2286-2296
- 32 Ducarme G, Revaux A, Rodrigues A. et al . Obstetric outcome following laparoscopic adjustable gastric banding. Int J Gynaecol Obstet. 2007; 98 244-247
- 33 Dixon J B, Dixon M E, O'Brien P E. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol. 2005; 106 965-972
- 34 Dixon J B, Dixon M E, O'Brien P E. Pregnancy after Lap-Band surgery: management of the band to achieve healthy weight outcomes. Obes Surg. 2001; 11 59-65
- 35 Skull A J, Slater G H, Duncombe J E. et al . Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes. Obes Surg. 2004; 14 230-235
- 36 Patel J A, Patel N A, Thomas R L. et al . Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008; 4 39-45
- 37 Richards D S, Miller D K, Goodman G N. Pregnancy after gastric bypass for morbid obesity. J Reprod Med. 1987; 32 172-176
- 38 Wittgrove A C, Jester L, Wittgrove P. et al . Pregnancy following gastric bypass for morbid obesity. Obes Surg. 1998; 8 461-464
- 39 Landsberger E, Ankrah Y, Segal-Isaacson C. et al . Should severely obese women complete childbearing prior to undergoing bariatric surgery?. Am J Obstet Gynecol. 2006; 195 S93
- 40 Friedman D, Cuneo S, Valenzano M. et al . Pregnancies in an 18-Year Follow-up after Biliopancreatic Diversion. Obes Surg. 1995; 5 308-313
- 41 Kral J G, Biron S, Simard S. et al . Large maternal weight loss from obesity surgery prevents transmission of obesity to children who were followed for 2 to 18 years. Pediatrics. 2006; 118 e1644-e1649
- 42 Weintraub A, Levy A, Levy I. et al . Downsizing gestational complications: Pregnancy outcomes before and after bariatric surgery. Am J Obstet Gynecol. 2007; 197 S186
- 43 Sheiner E, Levy A, Silverberg D. et al . Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol. 2004; 190 1335-1340
- 44 Wax J R, Cartin A, Wolff R. et al . Pregnancy following gastric bypass surgery for morbid obesity: maternal and neonatal outcomes. Obes Surg. 2008; 18 540-544
- 45 Atkinson R L, Dahms W T, Bray G A. et al . Plasma zinc and copper in obesity and after intestinal bypass. Ann Intern Med. 1978; 89 491-493
- 46 Pajecki D, Dalcanalle L, Souza de Oliveira C P. et al . Follow-up of Roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg. 2007; 17 601-607
- 47 Balsa J A, Botella-Carretero J I, Peromingo R. et al . Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion. J Endocrinol Invest. 2008; 31 845-850
- 48 Griffith D P, Liff D A, Ziegler T R. et al . Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery. Obesity (Silver Spring). 2009; 17 827-831
- 49 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. 2009; 19 738-744
- 50 Makarewicz W, Kaska L, Kobiela J. et al . Wernicke's syndrome after sleeve gastrectomy. Obes Surg. 2007; 17 704-706
- 51 Gasteyger C, Suter M, Gillard R C. et al . Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008; 87 1128-1133
- 52 Gehrer S, Kern B, Peters T. et al . Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB) – a prospective study. Obes Surg. 2010; 20 447-453
- 53 Bothwell T H. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000; 72 257S-264S
- 54 Granstrom L, Granstrom L, Backman L. Fetal growth retardation after gastric banding. Acta Obstet Gynecol Scand. 1990; 69 533-536
- 55 Haddow J E, Hill L E, Kloza E M. et al . Neural tube defects after gastric bypass. Lancet. 1986; 1 1330
- 56 Martin L, Chavez G F, Adams Jr M J. et al . Gastric bypass surgery as maternal risk factor for neural tube defects. Lancet. 1988; 1 640-641
- 57 Van M T, Van S D, Depiere M. et al . Fetal cerebral hemorrhage caused by vitamin K deficiency after complicated bariatric surgery. Obstet Gynecol. 2008; 112 434-436
- 58 Referenzwerte für die Nährstoffzufuhr. Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährung. Neustadt an der Weinstraße; Neuer Umschau Buchverlag 2008
Prof. Dr. Bernd Schultes
Interdisziplinäres Adipositas-Zentrum
Kantonsspital St. Gallen
Heidener Straße 11
9400 Rorschach, Schweiz
Telefon: 0041-(0)71-858 36 24
Fax: 0041-(0)71-858 36 29
eMail: bernd.schultes@kssg.ch
URL: http://www.obesity.ch