Health risks to babies born TOO SOON after bariatric surgery

[DianaCox]

http://www.gastroendonews.com/Web-O...-Face-Increased-Risks/39031/ses=ogst?enl=true

"However, these risks to the newborn are attenuated when more time passes between a woman’s bariatric procedure and the birth of her child. Infants born to women more than four years after surgery, compared with those whose mothers were less than two years out from surgery, had a reduced risk for prematurity (11.8% vs. 17.2%), NICU admission (12.1% vs. 17.7%), and small size for gestational age (9.2% vs. 12.7%)—a risk profile approaching that of the baseline population."​

This article omitted the very concerning effects of pregnancy while in ketosis:

BMC Pregnancy Childbirth. 2013 May 8;13:109. doi: 10.1186/1471-2393-13-109.
Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse.
Sussman D1, van Eede M, Wong MD, Adamson SL, Henkelman M.
Author information

Abstract
BACKGROUND:
The increasing use of the ketogenic diet (KD), particularly by women of child-bearing age, raises a question about its suitability during gestation. To date, no studies have thoroughly investigated the direct implications of a gestational ketogenic diet on embryonic development.

METHODS:
To fill this knowledge gap we imaged CD-1 mouse embryos whose mothers were fed either a Standard Diet (SD) or a KD 30 days prior to, as well as during gestation. Images were collected at embryonic days (E) 13.5 using Optical Projection Tomography (OPT) and at E17.5 using Magnetic Resonance Imaging (MRI).

RESULTS:
An anatomical comparison of the SD and KD embryos revealed that at E13.5 the average KD embryo was volumetrically larger, possessed a relatively larger heart but smaller brain, and had a smaller pharynx, cervical spinal cord, hypothalamus, midbrain, and pons, compared with the average SD embryo. At E17.5 the KD embryo was found to be volumetrically smaller with a relatively smaller heart and thymus, but with enlarged cervical spine, thalamus, midbrain and pons.

CONCLUSION:
A ketogenic diet during gestation results in alterations in embryonic organ growth. Such alterations may be associated with organ dysfunction and potentially behavioral changes in postnatal life.​

I wish they had ALSO addressed the fact that the babies of women who have them after bariatric surgery (assuming they waited a decent amount of time): http://www.cbsnews.com/news/moms-who-had-weight-loss-surgery-may-pass-on-healthier-genes/

Differential methylation in glucoregulatory genes of offspring born before vs. after maternal gastrointestinal bypass surgery​

1. 1. Frédéric Guénarda,
   2. Yves Deshaiesb,c,
   3. Katherine Cianfloneb,c,
   4. John G. Krald,
   5. Picard Marceauc,e, and
   6. Marie-Claude Vohla,1

Edited by C. Ronald Kahn, Joslin Diabetes Center, Harvard Medical School, Boston, MA, and approved April 30, 2013 (received for review October 10, 2012)

Abstract
Obesity and overnutrition during pregnancy affect fetal programming of adult disease. Children born after maternal bariatric gastrointestinal bypass surgery (AMS) are less obese and exhibit improved cardiometabolic risk profiles carried into adulthood compared with siblings born before maternal surgery (BMS). This study was designed to analyze the impact of maternal weight loss surgery on methylation levels of genes involved in cardiometabolic pathways in BMS and AMS offspring. Differential methylation analysis between a sibling cohort of 25 BMS and 25 AMS (2–25 y-old) offspring from 20 mothers was conducted to identify biological functions and pathways potentially involved in the improved cardiometabolic profile found in AMS compared with BMS offspring. Links between gene methylation and expression levels were assessed by correlating genomic findings with plasma markers of insulin resistance (fasting insulin and homeostatic model of insulin resistance). A total of 5,698 genes were differentially methylated between BMS and AMS siblings, exhibiting a preponderance of glucoregulatory, inflammatory, and vascular disease genes. Statistically significant correlations between gene methylation levels and gene expression and plasma markers of insulin resistance were consistent with metabolic improvements in AMS offspring, reflected in genes involved in diabetes-related cardiometabolic pathways. This unique clinical study demonstrates that effective treatment of a maternal phenotype is durably detectable in the methylome and transcriptome of subsequent offspring.​

 

[Munchkin]

I wish people would take it more seriously when they are told not to get PG for at least a couple years post. Many people get the DS so they can get get PG. Maybe if it were easier to qualify people wouldn't be pushing the edge of their fertility window when they finally have surgery. As long as this is the case we will keep on hearing about high risk pregnancies.

Sigh!

 

[Larra]

People (and here I mean women) need to understand that the biological clock that is ticking when they are 39 was already ticking away when they were 25 or 30. Yet another reason to have bariatric surgery sooner rather than later.
And if anyone is feeling offended, please know that I understand that sometimes it just isn't the right time to have a baby, isn't the right relationship, etc etc. Just saying, it's best, if possible, to have your life in order so that when the right time comes along you can make the most of it.

 

[DianaCox]

I made the decision to have children at the worst time (in the middle of getting my PhD), with an inappropriate man (who was fun, at first, but in my heart I knew better). But I was told at 28 that it was now or never (recurring PID of unknown origin, already had lost one ovary), and it might already be too late. I didn't know I DIDN'T want kids, and he wanted to marry me, so I went for it. I think I would have been OK if I hadn't had kids, but even though I went through hell with him for 17 years, I got two kids whom I now wouldn't give up for anything - but I might never have had if I didn't commit to the crapshoot of "seeing what happened." (And the first pregnancy cured the PIDs - who knew?)

 

[Spiky Bugger]

Prior to 1935, the "elderly primipara" was somewhere between 25-40 years of age. In 1935, they adopted 35 years of age as the standard.

I first heard the term while, at age 28, I was in labor. (Seems some med schools had old textbooks.)

All this to mention that it isn't always the primipara who felt a need to get that way asap, but sometimes it is pressure from professionals who tell her that, for reproductive purposes, she's elderly...and had better get her ducks in a row.

 

[KathrynK]

There is no perfect time to have a baby if you are obese. If you have it when you are obese, you are passing on weight problems. If you have it after surgery, you are putting it at risk of other things. After a series of heartbreaking miscarriages in my late 30s, including one very late in pregnancy, I had my second child at age 42. I gained weight after each miscarriage, especially the one at 28 weeks, who we had already named. So, I was overweight when she was conceived, and now I see her struggle with weight as a young adult and feel responsible. I tell myself she might not have been born at all, if I took time off to have surgery. One thing to think about is getting your vitamin levels in normal range is even more important. One of the autism theories is that low vitamin D in the mother poses a risk. Both too high and too low levels of some vitamins affect the kid's future health. We do the best we can in life and it is important to know the risks. Sometimes, though, you just have to throw the dice, if it is your last chance to have a daughter. I remind myself, my mothers health wasn't great when she gave birth to me (alcoholism and smoking), but at least she had me.

 

[KathrynK]

I was asked to provide evidence for the vitamin D and autism link, and I thought others might want it too. It is still a theory, as I said, and there are many theories.

Epidemiologic evidence for supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism
http://www.tandfonline.com/doi/full/10.4161/derm.1.4.9500

Vitamin D and autism: Clinical review
://www.sciencedirect.com/science/article/pii/S0891422212000431http

Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease
http://www.sciencedirect.com/science/article/pii/S0091302212000295

If you are aging and worried about Alzheimer's disease, you will never forget a dose of Vitamin D after reading this, unless you forget it because you have low vitamin D!
http://www.neurology.org/content/83/10/920.short
Vitamin D and the risk of dementia and Alzheimer disease