Pregnancy Outcomes After Bariatric Surgery
Pregnancy in women after undergoing bariatric surgery are by no means uncommon. There is even some evidence from case series to suggest that babies born to mothers, who have undergone surgery may be less likely to become obese or experience the cardiometabolic complications of obesity. This risk needs to be balanced against potential risks the known adverse effects of gastric bypass surgery on the metabolism of iron, vitamin B12, and folate, Now a paper by Karl Johansson and colleagues, published in the New England Journal of Medicine, suggests that this may well be the case. The researchers identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. They found that pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25) and a lower incidence of large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33). These potentially beneficial outcomes for the infant were counterbalanced by a two-fold increase in the likelihood of having a small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20) and a somewhat shorter gestation (mean difference -4.5 days) Also, the risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39). No differences were found in the frequency of congenital malformations. Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. Thus, the authors conclude that, “…a history of bariatric surgery was associated with reduced risks of gestational diabetes and large-for-gestational-age infants.” Nevertheless, they do recommend increased surveillance during pregnancy and the neonatal period, as bariatric surgery may also be associated with small-for-gestational-age infants, a shorter length of gestation, and potentially an increased risk of stillbirth or neonatal death. @DrSharma Edmonton, AB
Early Bird Registration For Canadian Obesity Summit Ends March 3rd
For all my Canadian readers (and any international readers planning to attend), here just a quick reminder that the deadline for early bird discount registration for the upcoming 4th Canadian Obesity Summit in Toronto, April 28 – May 2, ends March 3rd. To anyone who has been at a previous Canadian Summit, attending is certainly a “no-brainer” – for anyone, who hasn’t been, check out these workshops that are only part of the 5-day scientific program – there are also countless plenary sessions and poster presentations – check out the full program here. Workshops: Public Engagement Workshop (By Invitation Only) Pre-Summit Prep Course – Overview of Obesity Management ($50) Achieving Patient‐Centeredness in Obesity Management within Primary Care Settings Obesity in young people with physical disabilities CON-SNP Leadership Workshop: Strengthening CON-SNP from the ground up (Invitation only) Exploring the Interactions Between Physical Well-Being and Obesity Healthy Food Retail: Local public‐private partnerships to improve availability of healthy food in retail settings How Can I Prepare My Patient for Bariatric Surgery? Practical tips from orientation to operating room Intergenerational Determinants of Obesity: From programming to parenting Neighbourhood Walkability and its Relationship with Walking: Does measurement matter? The EPODE Canadian Obesity Forum: Game Changer Achieving and Maintaining Healthy Weight with Every Step Adolescent Bariatric Surgery – Now or Later? Teen and provider perspectives Preventive Care 2020: A workshop to design the ideal experience to engage patients with obesity in preventive healthcare Promoting Healthy Maternal Weights in Pregnancy and Postpartum Rewriting the Script on Weight Management: Interprofessional workshop SciCom-muniCON: Science Communication-Sharing and exchanging knowledge from a variety of vantage points The Canadian Task Force on Preventive Health Care’s guidelines on obesity prevention and management in adults and children in primary care Paediatric Obesity Treatment Workshop (Invitation only) Balanced View: Addressing weight bias and stigma in healthcare Drugs, Drinking and Disordered Eating: Managing challenging cases in bariatric surgery From Mindless to Mindful Waiting: Tools to help the bariatric patient succeed Getting Down to Basics in Designing Effective Programs to Promote Health and Weight Loss Improving Body Image in Our Patients: A key component of weight management Meal Replacements in Obesity Management: A psychosocial and behavioural intervention and/or weight loss tool Type 2 Diabetes in Children and Adolescents: A translational view Weight Bias: What do we know and where can we go from here? Energy Balance in the Weight- Reduced Obese Individual: A biological reality that favours… Read More »
Pregnancy Weight Gain Study
Today’s post is for health professionals who provide care to pregnant women in their practice? Researchers from the University of Alberta are conducting a short online survey to get a better understanding of the barriers and challenges you may experience related to gestational weight gain, and about what may help and support them to help women achieve healthy weights during pregnancy. The researchers are also asking you to assess the strengths and limitations of the 5As of Healthy Pregnancy Weight Gain, a new resource from the Canadian Obesity Network. This information will help to inform the development of universal strategies that promote healthy dietary intake and appropriate weight management in pregnancy and postpartum. Your participation in this short survey is much appreciated. Click here to take the survey. @DrSharma Edmonton, AB
Are Sedentary Moms Promoting Childhood Obesity?
Last week, Edward Archer from the University of Alabama at Birmingham (UAB), published a paper in the Mayo Clinic Proceedings (to much media fanfare), suggesting that the primary driver of childhood obesity is the shifting of nutrient energy to fetal adipose tissue as a result of increased maternal energy availability paired with decreased maternal energy expenditure, resulting in fetal pancreatic b-cell and adipocyte hyperplasia – a theory, which Edwards labels the “maternal resource hypothesis”. The primary process for these changes, as readers of these pages will have read before, is through epigenetic modification of DNA, which, together with other non-genetic modes of transmission including learned behaviours and environmental exposures (socioenvironmental evolution), leads to “phenotypic evolution”, which Edward describes as, “…a unidirectional, progressive alteration in ontogeny that is propagated over multiple successive generations and may be quantified as the change over time in the population mean for the trait under examination (eg, height and obesity).” Since the beginning of the 20th century, socioevironmental factors have significantly altered the energy balance equation for humans “Socioenvironmental evolution has altered the evolution of human energy metabolism by inducing substantial decrements in EE imposed by daily life while improving both the quality and the quantity of nutrient-energy availability.” “For example, as thermoneutral environments became ubiquitous, the energy cost of thermoregulation declined, and improved sanitation (eg, clean water and safer food) and vaccinations decreased the energy cost of supporting parasites (eg, fleas) and resisting pathogens (eg, communicable diseases and diarrheal infections).” Over the past century, these developments have led to profound phenotypic changes including, “progressive and cumulative increases in height, body stature and mass, birthweight, organ mass, head circumference, fat mass/adiposity as well as decreases in the age at which adolescents attain sexual maturity…” Archer goes on to describe some of the many factors that may have changed in the past century, whereby, he singles out sedentariness as one of the key drivers of these developments (not surprising given Archer’s background in exercise science). Thus, although one could perhaps make very similar arguments for any number of factor that may have changed in the past century to, in turn, affect insulin resistance and ultimately energy partitioning (change in diet, sleep deprivation, increasing maternal age, endocrine disruptors, antibiotic use, gut microbiota, medication use and many other factors I ca think of), Archer chooses to elevate sedentariness to being the main culprit. While this may or may not be the full… Read More »
Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015
Building on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto. If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world. In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof. The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians. The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field. Abstract submission is now open – click here Key Dates Notification of abstract review: January 8, 2015 Call for late breaking abstracts open: Jan 12-30, 2015 Notification of late breaking abstracts and handouts and slides due : Feb 27, 2015 Early registration deadline: March 3, 2015 For exhibitor and sponsorship information – click here To join the Canadian Obesity Network – click here I look forward to seeing you in Toronto next year! @DrSharma Montreal, QC
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