Curbing Obesity from One Generation to Another: the Effects of Bariatric Surgery on the In Utero Environment and Beyond
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REVIEW
Curbing Obesity from One Generation to Another: the Effects of Bariatric Surgery on the In Utero Environment and Beyond Redin A. Spann 1 & Bernadette E. Grayson 1 Received: 8 April 2020 / Accepted: 25 May 2020 # Society for Reproductive Investigation 2020
Abstract Approximately 250,000 individuals seek bariatric surgery each year in the USA for the long-term resolution of obesity-related comorbidities. Greater than 80% of these individuals are women and approximately half are of child-bearing age. Although there are many positive metabolic benefits that are realized through surgical weight loss for both men and women, the various long-term hormonal, molecular, nutrient, and epigenetic changes following bariatric surgery have not been evaluated for the surgical recipient or in the context of pregnancy and the offspring. Pregnancy may be a vulnerable period of time for the bariatric surgery recipient, and thoughtful consideration of pregnancy management should be taken by health care providers and recipients alike. The purpose of this review is to explore potential etiologies of some of the gestation-specific outcomes for the mother and offspring. Keywords Pregnancy . Body weight regulation . Bariatric surgery . Vertical sleeve gastrectomy . Obesity . Gestation
Introduction Obesity is a major health concern that is becoming more prevalent worldwide. The percentage of individuals who are obese, as defined as having a BMI ≥ 30, has more than doubled from 1980 to 2015 [1]. Women, however, are even more likely to be obese than men, reaching an incidence of nearly 15% compared with 10% respectively [1]. In the USA, 33% of women childbearing age are obese [2, 3] and 20% are obese at the beginning of pregnancy [4, 5]. Obesity is associated with several negative outcomes for the mother and child. For the mother, excess body weight leads to reproductive hormone dysfunction [6], altered menstrual cyclicity [7], and overall reduced fertility [3]. During gestation, there is increased risk for gestational diabetes [8], gestational hypertension [9], preeclampsia [10], prolonged pregnancies [11], and need for cesarean deliveries [12]. Maternal obesity during pregnancy also parlays long-term metabolic health risks to the fetus. Metabolic dysfunction prior to pregnancy carries a significant risk for both the mother and fetus.
* Bernadette E. Grayson [email protected] 1
Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
Bariatric surgery is an effective and durable treatment for obesity and is used increasingly around the world. Compared with lifestyle changes and pharmacological interventions, bariatric surgeries result in a significant amount of weight loss and drastic improvement in insulin sensitivity [13, 14]. In 2016, over 600,000 procedures were performed worldwide, with over 200,000 taking place in the USA [15]. Bariatric surgeries include restrictive surgeries such as gastric band and vertical sleeve gastrectomy (VSG) and ma
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