Schwangerschaft nach bariatrischer Operation

Obesity is an increasing problem of our society. Aside from life style interventions, bariatric surgery comes more and more into focus – especially in women of reproductive age. Bariatric surgery involves restrictive and malabsorptive procedures, which limit the amount of oral intake and reduce absorption of nutrients what leads to remarkable changes in metabolism and weight loss. Apart from a possible remission of type 2 diabetes, those surgeries lead to improved fertility and more pregnancies following bariatric procedures. The awareness about bariatric surgery in this reproductive age group and its impact on pregnancies and fetal outcomes seems not sufficient in our country. Surgeons, general practitioners, but also gynecologists and obstetricians should be informed about the need of preventive, primary preconceptional consultation and – once pregnant – close follow up’s in an interdisciplinary setting. In the first two years after surgery, a safe method of contraception should be followed to prevent pregnancies in the phase of greatest postoperative weight loss, which is associated with worse fetal and neonatal outcome. Preconceptionally and throughout the whole pregnancy repetitive laboratory measurements and supplementation of nutrients should be done to avoid possible and more frequent complications, such as SGA, FGR and fetal malformations. Regarding the actual data it is very likely that fetuses don’t show a»classic placental insufficiency« but more likely a kind of»atypical intrauterine fasting«. Regular sonography for biometric assessment as well as intensified prenatal care is recommended to identify possible risks in time. Because of the sparse data, more studies regarding the operative consequences for fetal and maternal outcome are needed. A better interdisciplinary collaboration, systematic registration and data on pregnancies after bariatric surgeries are needed for further evaluation.