ACOG Guidelines for Pregnancy After WLS

[Miss Vickie]

It's about time. You'll need to register to see the article, but it's free.

June 9, 2009 — The American College of Obstetricians and Gynecologists (ACOG) has issued a practice bulletin to summarize the risks for obesity in pregnancy and outcomes of pregnancy after bariatric surgery as well as to provide recommendations for management during pregnancy and delivery after bariatric surgery. The new guidelines are published in the June issue of Obstetrics & Gynecology.

"Obesity is associated with reduced fertility primarily as a result of oligo-ovulation and anovulation," write Michelle A. Kominiarek, MD, and colleagues from the ACOG. "The increased risks for gestational diabetes, preeclampsia, cesarean delivery, and infectious morbidity associated with obesity are well established....Obese patients are more likely to be admitted earlier in labor, need labor induction, require more oxytocin, and have longer labor."

To identify pertinent articles published in the English language between January 1975 and November 2008, the guidelines authors searched the MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents. The reviewers gave priority to articles reporting findings from original research and also consulted review articles and commentaries, but they did not consider abstracts of research presented at symposia and scientific conferences. Using the method outlined by the US Preventive Services Task Force, the reviewers evaluated the identified studies for methodologic quality.

Recommendations from professional societies including ACOG and the National Institutes of Health were also reviewed. Reference lists from identified articles were used to help identify additional studies. When reliable research findings were not available, the reviewers used expert opinions from obstetrician-gynecologists as a basis for their recommendations.

There's a bulleted list of things to consider before and during pregnancy after WLS. It's pretty thorough, and even though it's based on limited experience and data, it seems like a good start. I appreciated in particular the issue about testing therapeutic levels for medications on the post WLS patient, since I do wonder how much of our meds we actually absorb; I just think they should broaden that to ALL post-WLS patients.

I don't agree with all of the risks they cite with being pregnant and fat, however. Or if those risks do exist, I wonder how much of that is physician anxiety regarding the patient's perceived ill health. If they assume a fat woman will have a big baby, she's going to most likely be induced, which raises her risks for all kinds of interventions, including a cesarean section.

I thought this next bit was particularly surprising, although after thinking about it I suppose it shouldn't have surprised me:

• Because pregnancy rates after bariatric surgery in adolescents are twice that in the general adolescent population, contraceptive counseling is especially important in these patients.

Interesting article. I'm going to discuss it with my docs when I go back to work later this week.

 

[TraciJo67]

 

[Miss Vickie]

 

[HottiMegan]

 

[BeautifulPoeticDisaster]

 

[jenzers]

 

[Miss Vickie]