Gravidez após cirurgia bariátrica : resultados obstétricos, perinatais, crescimento e desenvolvimento das crianças

Abstract

Obesity has been reaching alarming indexes all over the world. The numbers are particularly high among young women, in reproductive age, who have been in great number submitted to bariatric surgery. With the consequent weight loss and improvement on the fertility, the number of pregnancies in the postoperative period has been increasing. This cross-sectional, descriptive, retrospective research, evaluated the obstetric and perinatal results of pregnancies in 19 women submitted to the bariatric surgery from 1999 to 2011, as well as the growth and development of children born before and after the surgery. The study was carried in the municipal district of Maringa, South of Brazil. From them 11 children were born before and 32 after the surgery. Previously to the surgery, 84.2% of the women showed obesity grade 3. The body mass index in the beginning of the pregnancies previous to the surgery showed 63.6% of obesity, with a weight gain above the ideal in 72.7% of them, in detriment of 26.7% of obesity in the beginning of the pregnancies occurred after the surgical procedure. It was evidenced weight gain below normal in 53.3% of the cases. High indexes of Cesarean section were found for the childbirths previous to the bariatric surgery (100%) as well for the ones subsequent to the surgical procedure (93.7%). The mean time between the surgery and the first pregnancy was of 42.96±29.05 months. Preterm newborn babies were found in greater percentage among the children born after the bariatric surgery (6-18.8%) than among the children born previous to the surgery (1-9.1%). In relation to the growth, normal weight was described in 27.3% and obesity in 54.5% of the children born before the surgical procedure, in detriment of normal weight in 59.4% and reduction of the obesity in 31.2% of the children born after the surgery. The excess of weight lost up to the pregnancy was of 64.88±22.89%. Three male children evaluated by the Development Screening Test Denver - II showed doubtful results, for they presented delay in the speech. They were born from C-section, full term, normal weight at the birth, in an interval of 3, 14 and 114 months after the surgery. In those pregnancies the weight gain was reported was adequate, below and above normal. Statistical association was found between the interval among surgery to pregnancy and the outcome of the suspect Denver II test (p= 0.011). Except for the largest index of low birth weight, it can be concluded that pregnancy after the surgery was shown to be safe, without important intercurrences for mother and child. The children's growth was found to be adequate, with obesity reduction. Although changes in the development of speech were detected, no factors were studied to support its association with pregnancy after surgery. Further researches are necessary on the subject.