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

Area of Science:

• Obstetrics and Gynecology
• Nutritional Science
• Maternal-Fetal Medicine

Background:

• Adequate vitamin A is crucial for pregnancy, but excessive intake can be teratogenic.
• Bariatric surgery can lead to micronutrient deficiencies, including vitamin A.
• Existing guidelines for vitamin A deficiency in pregnancy primarily address developing countries.

Observation:

• A patient with a history of bariatric surgery experienced 11 pregnancies with significant maternal and fetal complications.
• Maternal complications included visual disturbances, night blindness, and recurrent infections.
• Recurrent fetal pulmonary hypoplasia and microphthalmia resulted in fetal and neonatal loss.

Findings:

• The complications were potentially associated with vitamin A deficiency, alongside other micronutrient deficiencies and risk factors like smoking and obesity.
• Novel fetal complications (pulmonary hypoplasia, microphthalmia) linked to vitamin A deficiency in this context were observed.
• Nutritional management strategies for vitamin A and other micronutrients were implemented during the patient's last pregnancy.

Implications:

• Current vitamin A deficiency guidance is insufficient for pregnant women post-bariatric surgery in developed nations.
• There is an urgent need for specific antenatal nutritional guidance for this growing population.
• Improved nutritional management can mitigate risks for both mothers and offspring affected by post-bariatric surgery micronutrient deficiencies.