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Bariatric Surgery Before Pregnancy

Posted On : December 05, 2008

Newsmaker
This year has gone by very fast. One of the most significant changes that have taken place is the deployment of our electronic medical record system. We are on schedule to have the medical records of our new patients on a secured server stored electronically. This has been a on-going project and now we are aiming for a January 2009 complete deployment.
Ara Keshishian, MD, FACS

Calcium And Vitamin D May Not Be The Only Protection Against Bone Loss Diets that are high in protein and cereal grains produce an excess of acid in the body which may increase calcium excretion and weaken bones, according to a new study.

The study found that increasing the alkali content of the diet, with a pill or through a diet rich in fruits and vegetables has the opposite effect and strengthens skeletal health. “Heredity, diet, and other lifestyle factors contribute to the problem of bone loss and fractures,” said Bess Dawson-Hughes, M.D., of Tufts University in Boston, Mass. and lead author of the study. “When it comes to dietary concerns regarding bone health, calcium and vitamin D have received the most attention, but there is increasing evidence that the acid/base balance of the diet is also important.”

Average older adults consume diets that, when metabolized, add acid to the body, said Dr.Dawson-Hughes. With aging, we become less able to excrete the acid. One way the body may counteract the acid from our diets is through bone resorption, a process by which bones are broken down to release minerals such as calcium, phosphates, and alkaline (basic) salts into the blood. Unfortunately, increased bone resorption leads to declines in bone mass and increases in fracture risk.

“When fruits and vegetables are metabolized they add bicarbonate, an alkaline compound, to the body,” said Dr. Dawson Hughes. “Our study found that bicarbonate had a favorable effect on bone resorption and calcium excretion. This suggests that increasing the alkali content of the diet may attenuate bone loss in healthy older adults.”

In this study, 171 men and women aged 50 and older were randomized to receive placebo or doses of either: potassium bicarbonate, sodium bicarbonate, or potassium chloride for three months. Researchers found that subjects taking bicarbonate had significant reductions in calcium excretion, signaling a decrease in bone resorption.

“In this study, we demonstrated that adding alkali in pill form reduced bone resorption and reduced the losses of calcium in the urine over a three month period,” said Dr. Dawson- Hughes. “This intervention warrants further investigation as a safe and well tolerated supplement to reduce bone loss and fracture risk in older men and women.”

Other researchers working on the study include Susan Harris, Nancy Palermo, Helen Rasmussen, and Gerard Dallal of Tufts University in Boston, Mass., and Carmen Castaneda-Sceppa of Northeastern University in Boston, Mass.

Bariatric Surgery Before Pregnancy Benefits Moms, Babies

Women who get pregnant after having weight-loss surgery have a lower risk of maternal and newborn complications than pregnant women who are obese, according to U.S. researchers who analyzed 75 studies.

Data from those studies showed that bariatric surgery in the United States increased by 800% between 1998 and 2005 (from 12,480 to 113,500). Women accounted for 83% of procedures among patients ages 18 to 45. Between 2003 and 2005, more than 50,000 women in this age group had inpatient bariatric surgery each year, which accounted for 49% of all bariatric surgeries.

The review authors found that pregnant women who’d had bariatric surgery had lower maternal complication rates than obese women, including gestational diabetes (0% vs. 22.1%) and preeclampsia (0% vs. 3.1%). In addition, maternal weight gain was reduced in women who’d had bariatric surgery.

Newborn outcomes among women who’d had laparoscopic adjustable band surgery were similar or better than outcomes among obese women: premature delivery, 7.7% vs. 7.1%; low birth weight, 7.7% vs. 10.6%; overly large body (macrosomia), 7.7% vs. 14.6%.

The findings were published in the Nov. 19 issue of the Journal of the American Medical Association.

“Research is needed to better delineate the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes,” the review authors wrote. “Optimizing success for contraception and producing healthy neonates following surgery will require a multidisciplinary effort by surgeons, primary care physicians, reproductive fertility specialists, obstetricians, and patients.”

Having bariatric surgery during childbearing years may change a woman’s fertility following weight loss, alter nutritional requirements during pregnancy, or impact contraception, the researchers noted. — Robert Preidt

Source: Journal of the American Medical Association, news release, Nov. 18, 2008

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