Cirugía bariátrica y embarazo: una revisión de la evidencia
Resumen
Introducción: La obesidad es una de las epidemias más impactantes e incontrolables, especialmente riesgosa en embarazadas. Dado lo anterior, la cirugía bariátrica aparece como la mejor alternativa para una significativa y sostenida pérdida de peso. En la práctica clínica poco se conoce sobre los cuidados de estas mujeres en estado grávido. Nuestro objetivo es aportar información acerca del manejo de pacientes intervenidas que deseen embarazarse y durante su gestación.
Materiales y Métodos: Se revisó literatura nacional e internacional, referente a beneficios, riesgos y recomendaciones para el control prenatal de gestantes previamente sometidas a estos procedimientos.
Desarrollo: Los resultados encontrados fueron heterogéneos, pero los estudios coinciden en que la cirugía bariátrica disminuye el riesgo de diabetes gestacional, síndrome hipertensivo del embarazo y macrosomía, concluyendo que las pacientes tienen embarazos más seguros. Por otro lado, estas mujeres pueden presentar déficits nutricionales, los cuales son mayores en procedimientos malabsortivos. Faltan más estudios para afirmar si la cirugía bariátrica aumenta la tasa de cesáreas, parto prematuro y restricción al crecimiento intrauterino (RCIU), aunque no parece ser el caso. Considerando estas indagaciones, se recomienda evitar embarazarse el primer año post-cirugía, y durante la gestación: mantener un buen control nutricional, vigilancia del crecimiento fetal, y la no-realización de la prueba de tolerancia a la glucosa.
Conclusión: A pesar de la diversidad de los estudios y considerando los riesgos versus beneficios, la cirugía bariátrica es recomendable en mujeres obesas que deseen embarazarse, asegurando un estricto control prenatal en gestaciones posteriores
Palabras clave:
cirugía bariátrica, embarazo, recomendacionesReferencias
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