Bariatric Surgery Clinical Trial
Official title:
Impact of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Fetal Growth and Relationship With the Nutritional Status of Pregnant Women
Background: There is a lack of evidence on whether maternal nutritional deficiencies after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) affect fetal development. The investigators hypothesis is that SG could induce nutritional deficiencies during pregnancy, as RYGB does, because of food restriction. These nutritional deficiencies may alter fetal growth. Methods: Women with singleton pregnancies who had at least one nutritional evaluation during pregnancy in our institution between 2006 and 2017 were included. The investigators evaluated nutritional deficiencies according to standard and pregnancy-specific norms. They have planned to study the relationships between these parameters and fetal growth. Objectives: To compare maternal nutritional parameters and neonatal outcomes after RYGB and SG and to assess the impact of nutritional alterations on fetal growth.
Design: this study is a retrospective observational study, based on a single-centre database
established since 2004 at the Louis Mourier Hospital in patients who have undergone bariatric
surgery. This study focuses on women who have had at least one nutritional assessment at
Louis Mourier Hospital during their pregnancy between 2004 and 2017. Clinical and biological
data from the database and the data from delivery collected for usual care will be used
retrospectively for this study. Main objective: to compare fetal growth after SG and RYGB.
Primary endpoint: measurement of birth weight.
Secondary objectives and endpoints: - to compare fetal growth after SG and RYGB adjusted for
gestational age and sex (birth weight Z-score).
- to compare the number of small for gestational age after SG and RYGB (birth weight
Z-score <10 th percentile)
- to compare after SG and RYGB nutritional parameters including the following evaluation
criteria:
1. Before pregnancy: weight and body mass index, weight loss between surgery and early
pregnancy
2. During pregnancy: weight gain, dietary intake, biological parameters measured in
the second trimester of pregnancy, in blood (iron, ferritin, transferrin
saturation, calcium, magnesium, albumin, pre-albumin, vitamins A , D, E, C, B1, B6,
B9, B12, zinc, selenium, parathyroid hormone, homocysteine, hemoglobin, mean cell
volume, hematocrit, blood glucose, triglycerides, cholesterol, insulin) and urine
(calcium, urea, creatinine).
- to compare the number of nutritional deficiencies (number of deficiencies for each
parameter listed above) after SG and RYGB with standard and pregnancy norms.
- to compare the type of deficiency after SG and RYGB (difference between the 2 types of
surgery for each parameter)
- to study the relationship between nutritional parameters and fetal growth after
bariatric surgery (correlations between concentrations of nutritional parameters, birth
weight and birth weight Z-score)
- to study the relationship between nutritional parameters and fetal growth after each
type of surgery (SG and RYGB).
Population studied: pregnant women after bariatric surgery including RYGB and SG. Practical
implementation: for women who are referred to our institution during pregnancy, systematic
vitamin supplementation is prescribed and then adjusted according to the nutritional dosages
performed at least once a trimester. All women benefit from a systematic investigation, which
includes a medical consultation, a dietary survey and fasting biological tests according to
our routine post-operative evaluation. These data are prospectively collected in a database.
They will be used for the study retrospectively. The birth data collected in the medical file
at the end of the pregnancy will also be used for the study retrospectively. An oral
agreement was obtained from all women for the collection of these data for research and a non
opposition form was sended. A questionnaire was sent to women for whom there was missing data
concerning their delivery.
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