ABSTRACT
Growing numbers of women today will seek bariatric surgery before pregnancy. Protein-calorie malnutrition; hyperemesis; intestinal hernias; dumping syndrome; anemia; and deficiencies in calcium, folic acid, and vitamins B12, D, and K are all possible complications that can impact pregnancy. This article reviews the nutritional and pregnancy-related consequences of current surgical procedures and summarizes existing research showing positive and negative effects of weight-loss surgery on pregnancy outcomes. Practice-based clinical recommendations will help guide clinicians caring for the increasing number of women who become pregnant after having bariatric surgery.
Subject(s)
Bariatric Surgery/adverse effects , Midwifery/methods , Pregnancy Complications/nursing , Pregnancy Complications/prevention & control , Prenatal Care/methods , Women's Health , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/prevention & control , Avitaminosis/etiology , Avitaminosis/prevention & control , Female , Health Knowledge, Attitudes, Practice , Humans , Malabsorption Syndromes/etiology , Malabsorption Syndromes/prevention & control , Malnutrition/etiology , Malnutrition/prevention & control , Nurse's Role , Obesity, Morbid/surgery , Pregnancy , Pregnancy Complications/etiology , Risk FactorsABSTRACT
Pregnancy is a critical time for women struggling with disordered eating and weight concerns. For the majority of women with eating disorders, symptoms improve during pregnancy. Other women, particularly those with either subclinical or binge eating disorders, are at risk for an escalation of pathologic behaviors, putting both mother and fetus at risk for negative birth outcomes. Routinely screening for eating disorders will help identify those women who will most benefit from specialized care. Attention must be paid to possible harmful comorbid behaviors found in women with eating disorders, such as smoking, alcohol use, abusing laxatives or herbal supplements, and self-injurious behavior. This article reviews the mixed research findings of the impact of eating disorders upon pregnancy and identifies key times in prenatal care where nutritional counseling and specific interventions will increase the likelihood of positive pregnancy outcomes. The postpartum period is another critical time for provider intervention that may lower women's risks for eating disorder relapse, postpartum depression, and breastfeeding difficulties.
Subject(s)
Feeding and Eating Disorders/prevention & control , Health Education/methods , Health Promotion/methods , Midwifery/methods , Mothers/education , Prenatal Care/methods , Diet/nursing , Feeding Behavior , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/epidemiology , Female , Humans , Maternal Behavior , Nursing Diagnosis/methods , Patient Education as Topic/methods , Patient Education as Topic/statistics & numerical data , Practice Guidelines as Topic , Pregnancy , Prenatal Nutritional Physiological Phenomena , United StatesABSTRACT
Midwives are likely to encounter women seeking care before or after an elective abortion. National estimates of abortion rates suggest that 43% of women in the United States will have at least one abortion by the time they are 45 years old. By not asking women about abortion experiences, providers risk perpetuating women's guilt, shame, and silence. This article describes the emotional consequences of elective abortion, identifies women at high risk for negative reactions, and offers approaches to counseling about the psychosocial effects of abortion both before and after the procedure. Through the provision of counseling for women who have abortions, providers will be able to assist with coping, identify women who might be at greater risk for psychological sequelae, and offer referrals to those in need.
