Evaluating the Care Needs and Clinical and Nutritional Outcomes in Pregnant Women After Metabolic and Bariatric Surgery-A Tertiary Centre Experience.

Background: Metabolic and bariatric surgery (MBS) is used to achieve significant and sustained weight loss. Considerable MBS are performed on women of reproductive age, with limited data regarding risks and management pre-conception and peripartum.

Methods: Our retrospective audit assessed adult women in pregnancy with prior MBS, attending a specialised, multidisciplinary obesity service between January 2018 and July 2022. Baseline clinical and demographic characteristics, including surgical data, anthropometry, nutritional status, and pregnancy outcomes were collected for each pregnancy and evaluated.

Results: Across 189 women and 210 pregnancies, pre-pregnancy obesity (BMI ≥ 30) prevalence was 55.9%, with polycystic ovarian syndrome and type 2 diabetes and depression and anxiety the most common associated medical and mental health problems, respectively. One-sixth of pregnancies were conceived within 12 months of MBS. Of those with available data (n = 174), only 43.1% (n = 75) had preconception dietitian reviews. Second trimester iron deficiency was noted in 64.1% (107/167) (parenteral supplementation required in 23.8% (50/210)) and vitamin B12 deficiency in 46.2% (61/132) (parenteral supplementation administered in 32.9% (69/210)). Maternal and neonatal complications occurred in 43.8% and 45.7% of pregnancies. Special care nursery (SCN) or neonatal intensive care unit (NICU) admissions were higher than background population rates.

Conclusions: Women in pregnancy following MBS have complex medical and mental health backgrounds, limited pre-conception counselling and significant nutritional deficiencies, with higher rates of SCN/NICU admissions. Our study highlights the role of specialised pre-conception and perinatal services for these women.