Could Gastric Bypass In Teenage Girls Be Placing Their Future Children At Risk Of Birth Defects?
Doctors are concerned that is performing gastric bypass surgery on adolescents for the treatment of obesity may lead to their body does not absorb enough nutrients when they eat, so when they become pregnant their children are at greater risk of neural tube defects, the most common type of birth defects in the United States.
On the example of a young patient who, after coronary artery bypass surgery, then became pregnant and discovered that her unborn child had spina bifida, one of the most common neural tube defects, was presented at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco on Sunday .
A young woman went to a treatment center for fetal Francisco (UCSF's) University of California, San Benioff Children's Hospital to discuss the possibility of surgery on her unborn child.
Spina bifida and anencephaly are the most common types of neural tube defects, the most common birth defects in the U.S., affecting around one in 1000 live births.
Spina bifida, where the fetal spine does not close completely during the first month of pregnancy, there is usually damage to the nerves, resulting in at least partial if not complete paralysis of the legs.
Another common type of neural tube defects anencephaly, where most of the brain can not develop at all. Children with this condition were either born dead or die shortly after birth.
Studies show that getting enough folic acid, one of the B vitamins, both before and during pregnancy prevents the majority of neural tube defects.
Study investigators said that it is also well documented that gastric bypass surgery can lead to malabsorption, which leads to a lack of nutrients in several, including folate (folic acid).
However, while it is possible to overcome malabsorption of rigidly following recommended post-operative medicines and food scheme, which includes daily folate adolescent patients do not always adhere to the principles.
When the study's senior author, Dr. Diana L Farmer, chief of pediatric surgery at UCSF, and colleagues reviewed the literature, they found six more cases of children born with neural tube defects is considered as the result of lack of nutrients, particularly in relation to malabsorption in the mother following gastric bypass surgery.
They said that the situation was especially critical for adolescent girls who have undergone bypass surgery, because they have an increased risk of unwanted pregnancy.
Farmer, who is an internationally known expert on infant and fetal surgery, particularly for the treatment of spina bifida, said in a statement that she and her fellow researchers supported the idea that:
"... Suction folic acid, poor compliance with dietary supplements and a high risk of unwanted pregnancy places young women at increased risk for a complicated pregnancy with neural tube defects.
They went so far as to say it's a good excuse to stop teenage girls who have irreversible gastric bypasses:
"Although the epidemic of obesity in this country, we believe, irreversible gastric bypass surgery should be avoided among adolescent women, taking into account the potential increased risk of fetal neural tube defects," said the farmer.
But if the operation to go ahead, "greater efforts should be made to minimize the risks and unintended pregnancies and malnutrition," she urged.
"This should include extensive counseling before surgery, and frequent postoperative follow-up, and review of highly effective contraceptives such as intrauterine devices," said the farmer.
"Neural tube defects: Unanticipated Consequences of gastric bypass surgery in young patients? Catherine M. Lofberg, Diana L. Farmer, Elizabeth A. Gress, Robert H. Lustig, and Melvin B. Heyman. American Academy of Pediatrics National Conference and Exhibition, Sunday, Oct. 3, 2010, Abstract No. 11611.