Gastric Bypass and Pregnancy: A Bad Combination

The number of obese teens receiving gastric bypass surgery in America is growing. So are the reasons why the popular weight-loss remedy may not be such an easy fix.

Diana L. Farmer, MD, Chief of Pediatric Surgery at UCSF Benioff Children's Hospital in San Francisco, California has been studying the possible link between gastric bypass surgery in teen girls and an increased link for neural tube defects in their babies. Farmer presented her study at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco Sunday.

A neural tube defect (NTD) is an opening in the spinal cord or brain that occurs very early in development. In about the third or fourth weeks of pregnancy, specialized cells on the fetus's back begin to fuse and form the neural tube. When the neural tube does not close completely, an NTD develops. Spina Bifida is a well-known NTD.

One of the easiest ways for women to combat NTDs in their babies is to take pre-natal vitamins, especially those containing folic acid.

However, when gastric bypass surgery is involved, pregnant women must be even more diligent about taking their pre-natal vitamins, as the surgery makes it very difficult for the body to absorb important nutrients.

Teenage gastric bypass surgery recipients often don't receive the nutrients they need, as they tend to be forgetful or even rebellious when it comes to taking their vitamins, Farmer said.

"We postulate that the malabsorption of folate, poor compliance with nutritional supplements and a higher risk of unintended pregnancies places young women at an increased risk for pregnancies complicated with neural tube defects. Although obesity is epidemic in this country, we believe non-reversible gastric bypass surgery should be avoided in adolescent women given the potential increased risk of fetal neural tube defects," she said.

Farmer said that if gastric bypass surgery is performed on a teen-aged girl, "great efforts must be made to minimize the risks of both unintended pregnancies and nutritional deficiencies." She recommends extensive pre-surgery counseling and frequent post-operative follow-up, as well as consideration of a highly effective form for birth control, such as an intra-uterine device, or IUD.