TABLE 1.
Overview of case reports: maternal nutrient deficiencies after bariatric surgery and short- and long-term effects on the neonate1
| Study (reference) | Procedu re | Maternal Nutrientdeficiency | Maternal laboratory values2 | Supplementation | Neonatal complications | Long-term outcome |
| Bersani et al. (21) | BPD | Coagulopathy | PT: 72.3 (10.15) s | 2 × 10 mg/d Konakion (Roche Products Ltd) | Severe coagulopathy | Uncomplicated |
| INR: 5.7 (0.8 – 1.2) | ||||||
| Low vitamin K factors | F II: 19.1% (70–140%) | |||||
| F VII: 34.8% (70–140%) | ||||||
| F IX: 20% (70–140%) | ||||||
| F X: 10% (70–140%) | ||||||
| Protein C 50% (70–140%) | ||||||
| Protein S 33% (54–110%) | ||||||
| Cabano et al. (28) | BPD | None | No vitamin A | Preterm birth | Normal aortic measurements | |
| Bilateral microphthalmia | ||||||
| Respiratory distress | ||||||
| Enterocolitis | ||||||
| Aortic dilatation | ||||||
| Campbell et al. (29) | RYGB | Vitamin B-12 | 138 (228–1514) pg/mL | Stopped (side effects) | Vitamin B-12 deficiency | Uncomplicated |
| Celiker et al. (30) | RYGB | Vitamin B-12 | 84 pg/mL (unknown) | Oral multivitamin | Vitamin B-12 deficiency | Delayed gross motor |
| Delayed speech | ||||||
| Cools et al. (24) | BPD | Vitamin A | Not reported | Multivitamins | Congenital abnormalities | Retardation |
| Fe, Ca, Zn | Not reported | Fe | Preterm birth | Epilepsy | ||
| Packed cells | Severe anemia | Blind | ||||
| Deaf | ||||||
| Cools et al. (24) | BPD | Vitamin A | Not reported | Multivitamins | Preterm birth | Uncomplicated |
| Vitamin D | Not reported | Fe | ||||
| Fe, Zn, Ca, P | Not reported | Zn | ||||
| Cools et al. (24) | BPD | Vitamin B-12 | Not reported | Parenteral vitamins | Preterm birth | Uncomplicated |
| Vitamin A | Not reported | Packed cells | ||||
| Vitamin D | Not reported | TPN | ||||
| Ca, Se, Fe | Not reported | |||||
| Cools et al. (24) | BPD | Fe | Not reported | Vitamin B-12 | Cerebral cystic zones | Epilepsy |
| Fe | ||||||
| Eerdekens et al. (22) | AGB | Coagulopathy | PT: 46.8% (70–150%) | TPN | Preterm birth | Perinatal death |
| aPTT: 29.3 (24–31) s | Vitamin K deficiency bleeding | |||||
| Low vitamin K factors | F II: 56% (70–130%) | |||||
| F V: 121% (70–130%) | ||||||
| F VII: 40% (70–130%) | ||||||
| F IX: 75% (70–130%) | ||||||
| F X: 27% (70–130%) | ||||||
| Phylloquinone | 0.2 (0.8–5.3) nmol/L | |||||
| Eerdekens et al. (22) | AGB | None | NA | Not reported | Preterm birth | Perinatal death |
| Vitamin K deficiency bleeding | ||||||
| Eerdekens et al. (22) | AGB | None | NA | Not reported | Subdural hematoma | Delayed gross motor |
| Cerebral palsy | ||||||
| Eerdekens et al. (22) | BPD | None | NA | Not reported | Subarachnoidal bleeding | Mental retardation |
| Cerebral palsy | ||||||
| Eerdekens et al. (22) | BPD-D | Phylloquinone | 0.0008 (0.8–5.3) nmol/L | Not reported | Preterm birth | Perinatal death |
| Congenital abnormalities | ||||||
| Gilchrist et al. (25) | BPD | Vitamin A | 0.1 (1.6–2.3) μmol/L | Vitamin A (oral) | Bilateral microphthalmia | Ocular malformations |
| Vitamin D | 30 (50–300) nmol/L | Fe i.v. | Inferior adherent leukoma | Light-sensitive child | ||
| Vitamin K | Unknown | Optic nerve hypoplasia | ||||
| Fe | 3 (10–33) μmol/L | |||||
| Gomez-Lobo et al. (36) | RYGB | None | Not reported | Prenatal vitamins | None | None |
| Ferrous sulfate, 325 mg/d | ||||||
| Folic acid | ||||||
| Grange and Finlay (32) | BPD | Vitamin B-12 | 73 pmol/L (unknown) | Daily prenatal vitamin | Failure to thrive | Uncomplicated |
| incl 8 μg vitamin B-12 | Anemia | |||||
| Neutropenia | ||||||
| Gurewitsch et al. (33) | RYGB | Vitamin B-12 | 120 (226–966) pg/mL | Prenatal multivitamin | Uncomplicated | Uncomplicated |
| Fe | 10 (50–150) μg/dL | Ferrous sulfate, 325 mg/d | ||||
| Fe saturation | 2% (15–45%) | vitamin B-12 i.m. | ||||
| Huerta et al. (26) | BPD | Vitamin A | <0.2 (0.3–0.9) mg/L | Not during pregnancy | Premature birth | Retinal damage |
| Vitamin D | 6 (15–57) g/L | PP: multivitamin | Vitamin A deficiency | |||
| Vitamin B-12 | 153 (160–840) pg/mL | PP: ferrous sulfate, 325 mg/d | ||||
| Zn | 45 (65–256) μg/dL | |||||
| Iavazzo et al. (35) | RYGB | Fe | Not reported | Fe | Preterm birth | Unknown |
| Iavazzo et al. (35) | AGB | Fe | Not reported | Fe | Preterm birth | Unknown |
| Iavazzo et al. (35) | AGB | Folate | Not reported | Nutritional supplements | Unknown | Unknown |
| Moliterno et al. (34) | RYGB | None | NA | Folic acid | Open NTD | Uncomplicated |
| Vitamin B-12 | ||||||
| Pelizzo et al. (11) | RYGB | Folate | Not reported | None | NTD | Unknown |
| Vitamin B-12 | Fetal malformations | |||||
| Severe anemia | ||||||
| Pelizzo et al. (11) | RYGB | Folate | Not reported | None | NTD | Unknown |
| Vitamin B-12 | Fetal malformations | |||||
| Severe anemia | ||||||
| Pelizzo et al. (12) | RYGB | Vitamin B-12 | 201 (243–894) pg/mL | 22 wk: vitamins, minerals | NTD | Unknown |
| Vitamin A | 0.24 (0.25–0.86) μg/mL | Ventricular dilatation | ||||
| 1,25(OH)2D | 44.6 (48–110) pmol/L | |||||
| Fe | 16 (25–156) μg/dL | |||||
| Ferritin | 2 (18–440) μg/L | |||||
| Pelizzo et al. (12) | RYGB | Vitamin B-12 | <15 (243–894) pg/mL | 20 wk: vitamins, minerals | NTD | Unknown |
| Vitamin A | 0.1 (0.25–0.86) pg/mL | Ventricular dilatation | Unknown | |||
| 1,25(OH)2D | 40.3 (48–110) pmol/L | |||||
| Fe | 73 (25–156) μg/mL | |||||
| Ferritin | 10 (18–440) μg/dL | |||||
| Pelizzo et al. (12) | BPD | Not confirmed | Unknown | None | NTD | Failure to thrive |
| Bilateral microphthalmia | ||||||
| Sensorineural deafness | ||||||
| Skeletal dysplasia | ||||||
| Short limbs | ||||||
| Smets et al. (27) | BDP | Vitamin A | 17 (30–80) μg/dL (16 wk) | Multivitamin i.v. | Bilateral microphthalmia | Unknown |
| 14.5 μg/dL (30–80) (22 wk) | Vitamin B-12 | |||||
| Fe | ||||||
| Folic acid | ||||||
| Van Mieghem et al. (23) | AGB | Coagulopathy | PT: 12 s (not reported) | Water-soluble vitamins | Preterm birth | Perinatal death |
| aPTT: 29 s (not reported) | TPN | Cerebral hemorrhage | ||||
| Low vitamin K factors | F II: 56% (not reported) | |||||
| F VII: 40% (not reported) | ||||||
| F X: 27% (not reported) | ||||||
| Phylloquinone | 0.2 (0.8–5.3) nmol/L | |||||
| Vitamin A | 72 (300–650) μg/L | |||||
| Wardinsky et al. (31) | RYGB | None | NA | Not reported | Macrocytic anemia | Developmental delay |
| Vitamin B-12–deficient breast milk | Improvement at 12 mo | |||||
| Vitamin B-12 deficiency | ||||||
| Folate deficiency |
1
AGB, adjustable gastric banding; aPTT, activated partial thromboplastin time; BPD, biliopancreatic diversion; BDP-D, biliopancreatic diversion with duodenal switch; Ca, calcium; F, factor; Fe, iron; incl, including; INR, International Normalized Ratio; NA, not applicable; NTD, neural tube defect; P, phosphorus; PP, postpartum; PT, prothrombin time; RYGB, Roux-en-Y gastric bypass; Se, selenium; T, total parenteral nutrition; Zn, zinc; 1,25(OH)2D, 1,25-dihydroxyvitamin D.
2
Maternal laboratory values are presented as measured maternal values; reference intervals in parentheses.