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Neural Tube Defects: An Unforeseen Consequence of Gastric Bypass Surgery in Young Female Patients?

Sunday, October 3, 2010
Pacific H (San Francisco Marriott Marquis)
Katrine M. Lofberg, MD1, Diana L. Farmer, MD1, Elizabeth A. Gress, BA1, Robert H. Lustig, MD2 and Melvin B. Heyman, MD, MPH3, (1)Department of Surgery, Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA, (2)Department of Pediatrics, Division of Endocrinology, University of California San Francisco, San Francisco, CA, (3)Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California San Francisco, San Francisco, CA

Case Report

Increasingly, obese women of reproductive age are turning to gastric bypass surgery to achieve weight loss prior to conception. Recently, a patient who had undergone gastric bypass surgery prior to presentation was referred to the UCSF Fetal Treatment Center for consideration of surgery for her fetus with spina bifida. Review of the literature shows that increasing numbers of children are being born with neural tube defects (NTDs) due to maternal folate malabsorption following gastric bypass surgery.  Even though many patients are noncompliant with recommended vitamin supplementation regimens following bypass surgery, nutritional deficiencies may persist despite intensive vitamin supplementation, possibly due to unrelenting malabsorption.

Discussion

This disturbing situation underscores the importance of rigorous counseling and careful, vigilant follow up for gastric bypass candidates of reproductive age. It also increases skepticism and raises further questions pertaining to the appropriateness of offering this procedure to children and adolescents. Coupled with the numerous ethical concerns of pediatric bypass surgery and the potentially unavoidable risk of malnutrition, including vitamin deficiencies (such as Vitamins B1, D, and now likely folate), the possibility of future birth defects may outweigh the benefit of this bariatric procedure for reproductive-age girls and women.