Bariatric surgery increases the risk of nutritional deficiencies especially fat soluble vitamins including vitamin A. Levels in the mother influence fetal stores in the liver leading newborns to rely on maternal breast milk for their supply. We sought to determine the risk for maternal serum, cord blood, and breast milk vitamin A deficiency of post-bariatric surgery breastfeeding women compared to non-surgical controls.METHODS:
A prospective cohort study was conducted. Antepartum women with bariatric surgery, singleton pregnancies planning to breastfeed were recruited. Controls with singleton pregnancies, no history of malabsorption, planning to breastfeed were recruited randomly. Background information and pregnancy outcomes were collected. Third trimester serum and cord blood samples were obtained. Postpartum, participants completed a nutritional survey. Postpartum maternal serum was collected on day 1. Three milk samples were collected: colostrum (PPD1-5), transitional (PPD7-14), and mature milk (PP 6 weeks). Each sample was analyzed for retinol, retinyl esters, and total retinol by HPLC. Power analysis estimated a total of 66 patients.RESULTS:
53 bariatric women and 61 controls were recruited. Breastfeeding rates were significantly different between groups (51% bariatric women vs 23% in controls). Colostrum and transitional milk retinol was significantly higher in bariatric women vs controls (P=.01 and P=.02, respectively). Postpartum serum retinol was significantly higher in women with bariatric surgery compared to controls (P<.0001).CONCLUSION:
Vitamin A deficiency exists in the United States in the general urban population more than bariatric women. Consideration for monitoring levels in all breastfeeding women and supplementing is needed for maternal and newborn health.