"Bariatric" apparently derives from the Greek word "baros", meaning weight.

You are already familiar with it in the word "barometer"; an instrument to measure the weight of the air pressing down on you.

This type of surgery is becoming increasingly common and obstetricians need to be aware of its consequences in relation to pregnancy.

The American College of O&G issued guidelines about the management of pregnancy in patients after bariatric surgery in 2009.

It prefaced the guideline with a summary of some of the main things already know about obesity & pregnancy:

    reduced chance of becoming pregnant

    ­ risk of:

        gestational diabetes,

        pre-eclampsia,

        induction of labour, ­ syntocinon requirement,

        longer labour,

        Caesarean section,

        infection,

        stillbirth by up to a factor of 4.

Key points are:

    there are no agreed management regimes,

    bariatric surgery should not be done as a fertility treatment,

    waiting for up to 48 months after surgery to conceive may be helpful:

        to avoid the fetus growing in a possibly adverse environment occasioned by rapid weight loss,

        to allow the woman to achieve her weight goal,

    adolescents who have bariatric surgery are twice as likely as their peers to become pregnant, so need contraceptive counselling,

    oral contraception may fail because of malabsorption; depot will not,

    patients should be seen early by a bariatric surgeon,

    patients with adjustable gastric bands should be managed jointly with a bariatric surgeon,

    patients on drug therapy may need blood level assays to ensure enough is absorbed,

    complications of the bariatric surgery should be considered if abdominal symptoms occur,

    oral GTTs may be invalid because of "dumping" or malabsorption.

    Caesarean section rates are high: up to 62%,

    counselling should be given about nutrition and weight gain,

    patients should be seen by a nutritionist:

        to assist with coping with a suitable diet,

        to assist with coping with the physiological changes of pregnancy,

        to consider the possibility of "micronutrient deficiencies",

    if pregnancy occurs early after surgery (24 -48 months):

        closer monitoring of maternal weight and nutrition may be helpful,

        fetal growth monitoring may be helpful.

    there is an increased risk of PPROM after surgery   

    but there is a reduced risk of the following:

        congenital malformation,       

        gestational diabetes,

        hypertension and PET,

        fetal macrosomia.