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      What Is Known About the Nutritional Intake of Women during Pregnancy Following Bariatric Surgery? A Scoping Review

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          Abstract

          Optimising the diet and weight of women prior to and during pregnancy is of paramount importance to both maternal and offspring health. In women who become pregnant after bariatric surgery, evidence suggests a better overall obstetric outcome in comparison to women with severe obesity managed conservatively. Historically, most studies in this population group have monitored supplement adherence or serum concentrations of micronutrients, rather than dietary intake. The aim of this study was to synthesise current knowledge of the dietary intake of women during pregnancy following bariatric surgery. A systematic search of search engines was conducted using the following databases: MEDLINE, Embase, CINAHL, Cochrane database, Scopus, Trip, NHS Evidence, UK Clinical Trials, ClinicalTrials.gov, Prospero, Epistemonikos and Open Grey. Titles and abstracts were screened independently by two reviewers against predefined inclusion and exclusion criteria. After removal of duplicates, 1594 titles were identified, of which 1586 were initially excluded. Following full-text review, four articles were included. In total, across all four studies, data from only 202 bariatric surgery participants were included, the majority of whom had had one type of surgery. Just one study included a control group. Reporting of nutritional outcomes was heterogenous, with none of the studies including complete macro and micronutrient intake results in their articles. An insufficient intake of protein was noted as a concern in two studies and associated with poor fetal growth in one study. Overall, this review has identified a paucity of data about the dietary intake of women during pregnancy after bariatric surgery.

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          Guidance for conducting systematic scoping reviews.

          Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.
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            Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta‐analysis of European, North American, and Australian cohorts

            To assess the separate and combined associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of pregnancy complications and their population impact. Individual participant data meta-analysis of 39 cohorts. Europe, North America and Oceania. 265,270 births. Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large size for gestational age at birth. Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes and large size for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared to normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (Odds Ratio 2.51 (95% Confidence Interval 2.31, 2.74)). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large size for gestational age infants was attributable to excessive gestational weight gain. Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with the risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.
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              The adverse effects of obesity on conception and implantation.

              Whilst many multiparous women are obese (body mass index >30 kg/m(2)), obesity has been associated with impaired fecundity; however, the mechanism which links obesity to reduced fertility remains to be fully elucidated. Obese women, particularly those with central obesity, are less likely to conceive per cycle. Obese women suffer perturbations to the hypothalamic-pituitary-ovarian axis, menstrual cycle disturbance and are up to three times more likely to suffer oligo-/anovulation. A fine hormonal balance regulates follicular development and oocyte maturation, and it has been observed that obesity can alter the hormonal milieu. Leptin, a hormone produced by adipocytes, is elevated in obese women, and raised leptin has been associated with impaired fecundity. Obesity impairs ovulation but has also been observed to detrimentally affect endometrial development and implantation. The expression of polycystic ovary syndrome (PCOS) is regulated, in part, by weight, and so obese women with PCOS often have a more severe phenotype and experience more subfertility. Obesity also impairs the response of women to assisted conception treatments. Weight loss through lifestyle modification or bariatric surgery has been demonstrated to restore menstrual cyclicity and ovulation and improve the likelihood of conception. In this article, we will discuss the effect of obesity upon key reproductive mechanisms and its relation to fertility treatments.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                05 September 2019
                September 2019
                : 11
                : 9
                : 2116
                Affiliations
                [1 ]School of Nursing and Midwifery, University of Plymouth, Devon, PL4 8AA, UK
                [2 ]Royal Cornwall Hospital Trust, Truro, Cornwall TR1 3LQ, UK
                [3 ]Department Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
                [4 ]Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, 2000 Antwerp, Belgium
                Author notes
                [* ]Correspondence: maslinkate@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-5580-803X
                https://orcid.org/0000-0001-5160-6684
                https://orcid.org/0000-0003-2718-4682
                Article
                nutrients-11-02116
                10.3390/nu11092116
                6770652
                31492000
                410f132a-20dd-40c0-bd51-0f83d52b6349
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 25 July 2019
                : 27 August 2019
                Categories
                Review

                Nutrition & Dietetics
                metabolic surgery,bariatric surgery,pregnancy,maternal dietary intake,scoping review

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