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DOI: 10.1055/a-1525-3243
Schwangerenbetreuung nach bariatrischer und postbariatrischer Operation
Die Betreuung von Patientinnen nach bariatrischer und postbariatrischer Operation erfordert die Beachtung einiger Besonderheiten in der präkonzeptionellen Beratung und während der Schwangerschaft. Der folgende Artikel legt den Fokus auf die Risiken und Komplikationen einer Schwangerschaft bei diesem besonderen Patientenkollektiv.
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Eine bariatrische Operation kann adipositasassoziierte Risiken einer Schwangerschaft senken.
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Schwangerschaften nach bariatrischer Operation bedürfen einer intensivierten Schwangerschaftsvorsorge.
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Orale Glukosetoleranztests sollen wegen des Risikos eines Dumping-Syndroms vermieden werden.
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Eine präkonzeptionelle Aufklärung über die Besonderheit einer Schwangerschaft und eine gute Compliance hinsichtlich der Gewichtsentwicklung und der Supplementation bestimmter Nährstoffe ist essenziell.
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Schwangerschaften nach Abdominoplastik scheinen ohne Nachteile für Patientin und Kind zu verlaufen. Das Frühgeburtsrisiko muss in weiteren Studien untersucht werden.
Publication History
Article published online:
22 June 2023
© 2023. Thieme. All rights reserved.
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Literatur
- 1 Bhatt DL, Steg PG, Ohman EM. REACH Registry Investigators. et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180-189 DOI: 10.1001/jama.295.2.180. (PMID: 16403930)
- 2 Schienkiewitz A, Mensink G, Kuhnert R. et al. Übergewicht und Adipositas bei Erwachsenen in Deutschland. J Health Monit 2017; 2: 21-28 DOI: 10.17886/RKI-GBE-2017-025.
- 3 Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005; 294: 1909-1917 DOI: 10.1001/jama.294.15.1909. (PMID: 16234497)
- 4 Welbourn R, Hollyman M, Kinsman R. et al. Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg 2019; 29: 782-795
- 5 Destatis – Statistisches Bundesamt. Qualitätsbericht Mikrozensus 2018. Accessed March 23, 2023 at: https://www.destatis.de/DE/Methoden/Qualitaet/Qualitaetsberichte/Bevoelkerung/mikrozensus-2018.pdf?__blob=publicationFile
- 6 Bell R, Glinianaia SV, Tennant PW. et al. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia 2012; DOI: 10.1007/s00125-012-2455-y.
- 7 Kleinwechter H, Schafer-Graf U, Buhrer C. et al. Diabetes and Pregnancy. Exp Clin Endocrinol Diabetes 2021; 129: S1-S8 DOI: 10.1055/a-1284-5758. (PMID: 33418592)
- 8 Bryan CS, Homeira K. Schwangerschaftsbetreuung nach Adipositas- oder metabolischer Chirurgie. Frauenheilkunde up2date 2018; 12: 419-436
- 9 Johnson K, Posner SF, Biermann J. CDC/ATSDR Preconception Care Work Group, Select Panel on Preconception Care. et al. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep 2006; 55: 1-23 (PMID: 16617292)
- 10 Stephenson J, Patel D, Barrett G. et al. How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals. PLoS One 2014; 9: e103085 DOI: 10.1371/journal.pone.0103085. (PMID: 25058333)
- 11 Bye A, Shawe J, Stephenson J. et al. Differences in pre-conception and pregnancy healthy lifestyle advice by maternal BMI: Findings from a cross sectional survey. Midwifery 2016; 42: 38-45
- 12 Tobias DK, Zhang C, van Dam RM. et al. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 2011; 34: 223-229
- 13 Schaefer-Graf U, Ensenauer R, Gembruch U. et al. Obesity and Pregnancy. Guideline of the German Society of Gynecology and Obstetrics (S3-Level, AWMF Registry No. 015–081, June 2019). Geburtshilfe Frauenheilkd 2021; 81: 279-303 DOI: 10.1055/a-1330-7466. (PMID: 33692590)
- 14 Koletzko B, Cremer M, Flothkotter M. et al. Diet and lifestyle before and during pregnancy – Practical recommendations of the Germany-wide Healthy Start – Young Family Network. Geburtshilfe Frauenheilkd 2018; 78: 1262-1282
- 15 Ramos A, Kow L, Brown W. et al. 5th IFSO Global Registry Report 2019. Accessed March 23, 2023 at: https://www.ifso.com/pdf/5th-ifso-global-registry-report-september-2019.pdf
- 16 AWMF. S3-Leitlinie: Chirurgie der Adipositas und metabolischer Erkrankungen. 2018 Accessed March 23, 2023 at: https://register.awmf.org/assets/guidelines/088–001l_S3_Chirurgie-Adipositas-metabolische-Erkrankugen_2018–02.pdf
- 17 Benaiges D, Mas-Lorenzo A, Goday A. et al. Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure?. World J Gastroenterol 2015; 21: 11804-11814
- 18 Hutter MM, Schirmer BD, Jones DB. et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011; 254: 410-420
- 19 Viscido G, Gorodner V, Signorini F. et al. Laparoscopic Sleeve gastrectomy: Endoscopic findings and gastroesophageal reflux symptoms at 18-month follow-up. J Laparoendosc Adv Surg Tech A 2018; 28: 71-77 DOI: 10.1089/lap.2017.0398. (PMID: 29227187)
- 20 Bazerbachi F, Vargas EJ, Abu Dayyeh BK. Endoscopic bariatric therapy: A Guide to the Intragastric Balloon. Am J Gastroenterol 2019; 114: 1421-1431 DOI: 10.14309/ajg.0000000000000239. (PMID: 31082868)
- 21 Jefferys AE, Siassakos D, Draycott T. et al. Deflation of gastric band balloon in pregnancy for improving outcomes. Cochrane Database Syst Rev 2013; (04) CD010048
- 22 Cai A, Maringa L, Hauck T. et al. Body Contouring Surgery Improves Physical Activity in Patients After Massive Weight Loss-a Retrospective Study. Obes Surg 2020; 30: 146-153 DOI: 10.1007/s11695-019-04145-3. (PMID: 31444775)
- 23 Hauck T, Schmitz M, Horch RE. et al. Operating on the edge? Body contouring procedures in patients with Body Mass Index greater 35. Obes Surg 2019; 29: 1563-1570
- 24 Mechanick JI, Youdim A, Jones DB. et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 (Suppl. 1) S1-S27 DOI: 10.1002/oby.20461. (PMID: 23529939)
- 25 Busetto L, Dicker D, Azran C. et al. Practical recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts 2017; 10: 597-632 DOI: 10.1159/000481825. (PMID: 29207379)
- 26 Vanheule G, Ceulemans D, Vynckier AK. et al. Micronutrient supplementation in pregnancies following bariatric surgery: a practical review for clinicians. Obes Surg 2021; 31: 4542-4554 DOI: 10.1007/s11695-021-05546-z. (PMID: 34304377)
- 27 Dragu A, Schnurer S, Horbach T. et al. Evaluation of intra-operative abdominal wall perfusion in post-bariatric abdominal dermolipectomy. Obes Facts 2012; 5: 651-659 DOI: 10.1159/000343662. (PMID: 23108184)
- 28 Dragu A, Horch RE. Concept of reconstructive body shaping in obesity. Evidence-based therapy algorithm. Chirurg 2014; 85: 37-41 DOI: 10.1007/s00104-013-2628-3. (PMID: 24132586)
- 29 Dixon JB, Dixon ME, O’Brien PE. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005; 106: 965-972 DOI: 10.1097/01.AOG.0000181821.82022.82. (PMID: 16260513)
- 30 Weng TC, Chang CH, Dong YH. et al. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open 2015; 5: e006964 DOI: 10.1136/bmjopen-2014-006964. (PMID: 26185175)
- 31 Galazis N, Docheva N, Simillis C. et al. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014; 181: 45-53 DOI: 10.1016/j.ejogrb.2014.07.015. (PMID: 25126981)
- 32 Getahun D, Fassett MJ, Jacobsen SJ. et al. Perinatal outcomes after bariatric surgery. Am J Obstet Gynecol 2022; 226: 121.e1-121.e16 DOI: 10.1016/j.ajog.2021.06.087.
- 33 Sesilia K, Susanna P, Virve K. et al. The outcome of pregnancies after bariatric surgery: an observational study of pregnancies during 2004–2016 in Finland. Arch Gynecol Obstet 2023; DOI: 10.1007/s00404-023-06935-8. (PMID: 36703011)
- 34 Schafer-Graf UM, Gembruch U, Kainer F. et al. Gestational Diabetes Mellitus (GDM) - Diagnosis, Treatment and Follow-Up. Guideline of the DDG and DGGG (S3 Level, AWMF Registry Number 057/008, February 2018). Geburtshilfe Frauenheilkd 2018; 78: 1219-1231 DOI: 10.1055/a-0659-2596. (PMID: 30651660)
- 35 Johansson K, Cnattingius S, Naslund I. et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med 2015; 372: 814-824 DOI: 10.1056/NEJMoa1405789. (PMID: 25714159)
- 36 Stothard KJ, Tennant PW, 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 DOI: 10.1001/jama.2009.113. (PMID: 19211471)
- 37 Moliterno JA, DiLuna ML, Sood S. et al. Gastric bypass: a risk factor for neural tube defects? Case report. J Neurosurg Pediatr 2008; 1: 406-409 DOI: 10.3171/PED/2008/1/5/406. (PMID: 18447680)
- 38 Van Mieghem T, Van Schoubroeck D, Depiere M. et al. Fetal cerebral hemorrhage caused by vitamin K deficiency after complicated bariatric surgery. Obstet Gynecol 2008; 112: 434-436 DOI: 10.1097/AOG.0b013e3181649e7b. (PMID: 18669754)
- 39 Jans G, Matthys C, Bogaerts A. et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Adv Nutr 2015; 6: 420-429 DOI: 10.3945/an.114.008086. (PMID: 26178026)
- 40 Gudbrand C, Andreasen LA, Boilesen AE. Internal Hernia in Pregnant Women After Gastric Bypass: a Retrospective Register-Based Cohort Study. Obes Surg 2015; 25: 2257-2262 DOI: 10.1007/s11695-015-1693-8. (PMID: 26041066)
- 41 Borman H. Pregnancy in the early period after abdominoplasty. Plast Reconstr Surg 2002; 109: 396-397 DOI: 10.1097/00006534-200201000-00070. (PMID: 11786850)
- 42 Averbuch Sagie R, Wiser I, Heller L. et al. Pregnancy reverses abdominoplasty aesthetic outcome: Myth or misconception? A cross-sectional study. Aesthet Surg J 2022; 42: NP20-NP26 DOI: 10.1093/asj/sjab356. (PMID: 34622279)
- 43 Pimentel VM, Powell K, Karkowsky CE. Is the cesarean delivery rate higher after abdominoplasty? Obstetrical outcomes in the setting of abdominoplasty [7C]. Obstet Gynecol 2016; 127: 28S
- 44 Parent B, Martopullo I, Weiss NS. et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg 2017; 152: 128-135
- 45 Villegas-Alzate FJ, Villegas-Mesa JD. Pregnancy after transverse plication lipoabdominoplasty, undermining halted at umbilicus, liposuction without restrictions, umbilicoplasty with a skin graft, and low transverse scar localization (TULUA). Literature review and case report. Rev Colomb Obstet Ginecol 2020; DOI: 10.18597/rcog.3567.