Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care.

The objective of the study is to provide evidence-based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow-up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print-friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high-quality evidence and warrant further research. These areas are highlighted in the paper.

Characteristics and mortality of severe hyponatraemia--a hospital-based study.

OBJECTIVE: To determine the characteristics, causes and outcome of severe hyponatraemia (< 125 mmol/l) in hospitalized patients, and to identify mortality predictors. DESIGN: Prospective case controlled study of sequentially presenting patients with a serum sodium (Na) < 125 mmol/l. PATIENTS AND METHODS: One hundred and four hyponatraemic and 104 randomly chosen normonatraemic (Na > 135 mmol/l) adult patients were studied. We measured hospital mortality and days in hospital, diagnoses, drug history and cause of hyponatraemia. Na was recorded at admission, as well as the closest level measured before death or discharge. In addition, the lowest Na was recorded (if this was not at admission). RESULTS: Hyponatraemic patients were older (mean age +/- 1 SD 69 +/- 14 years) than controls (61 +/- 16 years, P < 0.001), but of similar sex ratio. On admission, Na in the hyponatraemic group was 125 +/- 7 mmol/l compared with 139 +/- 3 mmol/l in controls (P < 0.0001), but fell to 120 +/- 4 mmol/l before rising at discharge to 131 +/- 7 mmol/l (all changes P < 0.001). Overall mortality was 27% in hyponatraemic patients compared with 9% in controls (P = 0.009), and length of admission was also greater (16 +/- 12 vs. 13 +/- 11 days, P < 0.005). Mortality was greater in patients whose Na levels fell during admission (34%vs. 16%, P < 0.05), and these patients appeared to have an excess of diuretic-induced and possibly iatrogenic hyponatraemia. CONCLUSIONS: Severe hyponatraemia in hospital patients is associated with prolonged admissions and significantly increased mortality compared with normonatraemic patients. A particular group at high risk of death are those whose Na levels fall after admission. They may represent a 'sicker' group, and deserve increased monitoring and surveillance.