1. Remesova T Jones L, Heath D, Sufi P Bariatric Surgery Department Whittington Hospital, London. United Kingdom

2. Nutrition Surgical issues Obstetrical issues

3. Nutrition Surgical issues Obstetrical issues

4.  Local algorithm  Roles in the multidisciplinary team – dietician, surgeon, obstetrician/midwife  20 patients, 22 pregnancies  1 week to 36 months post operatively

5.  Adjustment of supplements – vitamin A  Eating habits  Nutrition  Blood profile Zinc B12 / folic acid Haemoglobin / iron Vitamin D

6.  Band adjustment  Potential surgical issues

7. Gastric BANDSLEEVE gastrectomy Stretching the pouch Band adjustment Band slippage Stretching the pouch

8. Gastric BYPASS Duodenal SWITCH / Biliopancreatic bypass Malnutrition Internal hernias Ulcers

9.  Obesity + O&G risk assessment  Avoid oGTT in malabsorbtive procedures  Avoid preferably oral contraceptive  Immediate referral to dietician  Low threshold for surgical referral

10. DieticianSurgeonObstetrician / Midwife (Pre )ConceptionSupplement adjustment contraceptionReferral to bariatric dietician 1.TrimesterBloodsFollow up as indicated (FU) 2. TrimesterBloodsFU 3. TrimesterBloodsDeflate bandFU Post partumSupplement adjustment Inflate band

11.  Early referrals good outcome  Late referral IUGR  CS 30 weeks  Frequent vitamin deficiencies  corrected  2 subsequent pregnancies in two years  no weight loss

12. Tereza.Remesova@nhs.net ObsGynae.net Tereza.Remesova@nhs.net ObsGynae.net