Vitamin A and micronutrient deficiencies post-bariatric surgery: aetiology, complications and management in a complex multiparous pregnancy

Abstract

Adequate vitamin A is essential for healthy pregnancy, but high levels may be teratogenic. We present a patient who underwent bariatric surgery, prior to child bearing, and suffered maternal and foetal complications during eleven pregnancies, possibly associated with vitamin A deficiency, amongst multiple micronutrient deficiencies and risk factors including smoking and obesity. Maternal complications included visual disturbance, night blindness and recurrent infections. Recurrent foetal pulmonary hypoplasia and microphthalmia led to foetal and neonatal loss, not previously described in the medical literature. Current guidance on vitamin A deficiency in pregnancy is focused on developing countries where aetiology of vitamin A deficiency is different to that of women in developed countries. We describe nutritional management of the micronutritient deficiencies, focusing on vitamin A, during her last pregnancy. The need for specific antenatal nutritional guidance for pregnant women post-bariatric surgery is becoming more urgent as more mothers and offspring will be affected.

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References

  1. 1.

    Dibley M, Jeacocke D. Safety and toxicity of vitamin A supplements in pregnancy. Food Nutr Bull. 2001;22:248–66.

    Article  Google Scholar 

  2. 2.

    WHO. WHO Guideline: Vitamin A Supplementation In Pregnant Women. Geneva: World Health Organization; 2011.

    Google Scholar 

  3. 3.

    Pereira S, Saboya C, Chaves G, Ramalho A. Class III obesity and its relationship with nutritional status of vitamin A in pre- and postoperative gastric bypass. Obes Surg. 2009;19:738–44.

    Article  Google Scholar 

  4. 4.

    McArdle H, Ashworth C. Micronutrients in fetal growth and development. Br Med Bull. 1999;55:499–510.

    CAS  Article  Google Scholar 

  5. 5.

    Smets K, Barlow T, Vanhaesebrouck P. Maternal vitamin A deficiency and neonatal microphthalmia: Complication of biliopancreatic diversion? Eur J Pediatr. 2006;165:502–4.

    Article  Google Scholar 

  6. 6.

    NICE. Antenatal Care For Uncomplicated Pregnancies.. London: NICE; 2017.

    Google Scholar 

  7. 7.

    Machado S, Pereira S, Saboya C, Saunders C, Ramalho A. Influence of Roux-en-Y gastric bypass on nutritional status of vitamin A in pregnant women: a comparative study. Obes Surg. 2016;26:26–31.

    Article  Google Scholar 

  8. 8.

    Navarro I, Cunill J, Aguayo P, Conde S, Martínez J, Luna P. Resultados materno-fetales de la gestacion tras cirugia bariatrica. Nutr Hosp. 2011;26:376–83.

    Google Scholar 

  9. 9.

    King D, Siau K, Senthil L, Kane K, Cooper S. Copper deficiency myelopathy after upper gastrointestinal surgery. Nutr Clin Pract. 2017:epub ahead of print.

  10. 10.

    Rayman M, Bath S, Westaway J, Williams P, Mao J, Vanderlelie J, et al. Selenium status in UK pregnant women and its relationship with hypertensive conditions of pregnancy. Br J Nutr. 2015;113:249–58.

    CAS  Article  Google Scholar 

  11. 11.

    Gagné A, Wei SQ, Fraser WD, Julien P.Absorption, transport, and bioavailability of vitamin e and its role in pregnant women. J Obstet Gynaecol Can. 2009;31:210–217.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Mr Michael A Burdon for his ophthalmology expertise.

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Correspondence to Fiona L. Mackie.

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Dr SC Cooper has received honoraria and participated in advisory boards for Covidien, honoraria from Baxter, and educational sponsorship from Calea. Ms LJ Whitticase has participated in an advisory board for Fresenius Kabi.

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The patient has given informed written consent to allow the publication of her case history.

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Mackie, F.L., Cooper, N.S., Whitticase, L.J. et al. Vitamin A and micronutrient deficiencies post-bariatric surgery: aetiology, complications and management in a complex multiparous pregnancy. Eur J Clin Nutr 72, 1176–1179 (2018). https://doi.org/10.1038/s41430-018-0224-9

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