Gravidez após cirurgia bariátrica : implicações para a mãe e o recém-nascido

Abstract

This retrospective, exploratory and of cohort study had the aim to identify the implications to mother and newborn in pregnancies occurred post bariatric surgery where the studied sample was composed by female of childbearing ages (10 to 49 years) that were submitted to bariatric surgery and got pregnant during the post surgery period and were living in the city of Maringá, during the years from 1999 to 2008. A profile of patients submitted to bariatric surgery through a study of medical records of three hospitals of Maringá was primarily created. It was made 1916 surgeries where 76,24% was female and 23,76% was male patients. The average Body Mass Index (BMI) was 44,80 ± 6,95 in female and 47,37 ± 7,38 in male patients; the female average was 37,05 ± 11,50, and 34,23 ± 12,04 was male; the majority of the sample was Caucasian (96,56%) and had a sex partner (61,11%); 47,84% were living in Maringá and 97,71% did not presented surgical complications; 251 patients (13,69%) were hospitalized at the Intensive Care Unities (ICU); and seven patients died (0,37%). More evidenced comorbidities were noticed from arterial hypertension (16,76%), diabetes (4,74%) and dyspnea (3,06%). An association between obesity and co-morbidities as apnea, arthralgia, vascular diseases and dyspnea was found in a significance level of 5%. Other co-morbidities (arterial hypertension, dislipidemia and diabetes) were not associated to obesity. Later, records from a forth hospital were recovered totalizing 1951 patients and when submitting the inclusion criteria the results showed that 1486 surgeries (76,17%) were made in female where 1226 was in childbearing age and 586 were living in Maringa. A sample of 405 female with a 3 percent margin of error was calculated. The results showed an increase of 10 percent in the sample due to loss risks, totalizing 445 women. Using a simple randomized sampling it was identified 356 (80,00%) women that did not get pregnant after the bariatric surgery; 35 women got pregnant corresponding to 7,87%; 3 (0,67%) of them were pregnant during the interview; one woman (0,22%) refused to answer about the possibility of pregnancy; one selected patient died, unfortunately and 49 women (11,01%) were not available. From 35 women, 32 accepted participate in the research and 3 of them refused. The results of 32 women showed that: the majority was Caucasian; up to half of them had sex partners; high education level; presenting no co-morbidities associated to obesity; the majority did not present surgical complications; the average loss of weight was of 44,09 kg; the average interval between surgery and pregnancy was of 40 months; presented improvement of several co-morbidities post bariatric surgery although neuropsychiatric diseases and post surgery anemia were present; three post surgery abortions; caesarian delivery was prevalent; the majority of children presented normal birth weight, although the low birth weight values were higher than those informed by the Ministry of Health; the gestational age was at term; prevalence of male children, Caucasian, no anemia history; need of hospitalization of pregnant women in 36,58% of cases, blood transfusion due to anemia in 17,07% and minor hypertension cases compared to pregnancy before surgery procedure; breastfeeding presented shorter period in pregnancies occurred after bariatric surgery and the main reason to not breastfeed was less or absence of breast milk. It was not found association statistically significant among mother´s age and BMI, type of delivery, time between surgery and pregnancy, schooling and low birth weight. The pregnancy post bariatric surgery seems to be free from risk to both mother and newborn and although some pregnant women presented anemia it did not affected the newborn weight. Contraception matters after bariatric surgery must be discussed as well as studies related to the need of caesarian surgery due to be a pregnancy post bariatric surgery and increase the indexes of surgical delivery higher than the official numbers informed nowadays. The increase and development of children born after a post surgical period must be followed in order to cease doubts about this theme.