Obesity Surgery

, Volume 28, Issue 10, pp 3116–3124 | Cite as

Maternal Anthropometry and Its Relationship with the Nutritional Status of Vitamin D, Calcium, and Parathyroid Hormone in Pregnant Women After Roux-en-Y Gastric Bypass

  • Sabrina CruzEmail author
  • Andrea Cardoso de Matos
  • Suelem Pereira da Cruz
  • Silvia Pereira
  • Carlos Saboya
  • Andréa Ramalho
Original Contributions



To assess the influence of pre-pregnancy body mass index (BMI), total gestational weight gain (TGWG), and pre-pregnancy surgical success on the nutritional status of vitamin D, calcium, and parathyroid hormone (PTH) in the trimesters of pregnancy of women who previously underwent Roux-en-Y gastric bypass (RYGB).


This is an analytical, longitudinal, and retrospective study comprising 42 pregnant women who previously underwent RYGB. Concentrations of vitamin D3, calcium, and PTH were assessed in all trimesters. Anthropometric variables necessary for calculating TGWG, surgical success, and BMI were collected preoperatively and over the trimesters of pregnancy.


A total of 97.1% had vitamin D3 inadequacy at some point in pregnancy. Pre-pregnancy BMI, even when classified as overweight, may have exacerbated the serum concentrations of this vitamin in the third trimester (p = 0.011), and it was significantly lower in women with normal weight and/or obesity (p = 0.039). It was evidenced that both pre-pregnancy BMI and TGWG above the recommended optimal weight can be associated with calcium homeostasis, especially early in pregnancy. It was also shown that surgical success in the pre-pregnancy period may have influenced the serum concentrations of vitamin D in the second trimester of pregnancy (p = 0.013).


This study draws attention to the importance of monitoring the nutritional status of vitamin D3 and calcium in the prenatal period due to its relationship with pre-pregnancy BMI, TGWG, and surgical success.


Pregnancy Roux-en-Y gastric bypass Bariatric surgery Vitamin D Calcium Body mass index Obesity 



The authors acknowledge the support received from Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro) (Scientist of Our State).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement of Additional Informed Consent

Informed consent was obtained from all individual participants for whom identifying information is included in this article.


  1. 1.
    World Health Organization. Obesity and overweight. 2016. Available at:
  2. 2.
    Benoit SC, Hunter TD, Francis DM, et al. Use of bariatric outcomes longitudinal database (BOLD) to study variability in patient success after bariatric surgery. Obes Surg. 2014;24(6):936–43.PubMedGoogle Scholar
  3. 3.
    Lazear J, Lintner NC, Bode C, et al. Reproductive concerns and pregnancy after bariatric surgery: practice implications. Bariatr Nurs Surg Patient Care. 2012;7(2):75–82.CrossRefGoogle Scholar
  4. 4.
    Jungheim ES, Travieso JL, Hopeman MM. Weighing the impact of obesity on female reproductive function and fertility. Nutr Rev. 2013;71(1):S3–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Kaska L, Kobiela J, Abacjew-Chmylko A, et al. Nutrition and pregnancy after bariatric surgery. ISRN Obes. 2013;2013(492060):1–6.Google Scholar
  6. 6.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Aills L, Blankenship J, Buffington C, et al. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5Suppl):S73–S108.CrossRefPubMedGoogle Scholar
  8. 8.
    Nguyen TP, Yong HE, Chollangi T, et al. Placental vitamin D receptor expression is decreased in human idiopathic fetal growth restriction. J Mol Med (Berl). 2015;93(7):795–805.CrossRefGoogle Scholar
  9. 9.
    Pérez-López FR, Pasupuleti V, Mezones-Holguin E, et al. Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2015;103(5):1278–88.CrossRefPubMedGoogle Scholar
  10. 10.
    Thomas CE, Guillet R, Queenan RA, et al. Vitamin D status is inversely associated with anemia and serum erythropoietin during pregnancy. Am J Clin Nutr. 2015;102(5):1088–95.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Rodríguez-Dehli AC, Galán IR, Fernández-Somoano A, et al. Prevalencia de deficiencia e insuficiencia de vitamina D y factores associados em mujeres embarazadasdel norte de España. Nutr Hosp. 2015;31(4):1633–40.PubMedGoogle Scholar
  12. 12.
    Gillis LJ, Kennedy LC, Bar-Or O. Overweight children reduce their activity levels earlier in life than healthy weight children. Clin J Sport Med. 2006;16(1):51–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Pereira-Santos M, Costa PR, Santos CA, et al. Obesity and vitamin D deficiency: is there an association? Obes Rev. 2016;17:484.CrossRefPubMedGoogle Scholar
  14. 14.
    Heaney RP, Horst RL, Cullen DM, et al. Vitamin D3 distribution and status in the body. J Am Coll Nutr. 2009;28:252–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Wood RJ. Vitamin D and adipogenesis: new molecular insights. Nutr Rev. 2008;66:40–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Institute of medicine (IOM). Weight gain during pregnancy: reexamining the guidelines. Washington: National Academy Press; 2009.Google Scholar
  17. 17.
    Organização Mundial da Saúde. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva; 1998.Google Scholar
  18. 18.
    Gumbs AA, Pomp A, Gagner M. Revisional bariatric surgery for inadequate weight loss. Obes Surg. 2007;17(9):1137–45.CrossRefPubMedGoogle Scholar
  19. 19.
    Cummings DE, Overduin O, Foster-Schubert K. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2010;89(6):2608–15.CrossRefGoogle Scholar
  20. 20.
    Rocha Q, Mendonça S, Fortes R. Perda Ponderal após Gastroplastia em Y de Roux e importância do acompanhamento nutricional – Uma revisão de literatura. Ciências Saúde. 2011;22(1):61–70.Google Scholar
  21. 21.
    Andriolo A, Moreira SR, Silva LA, et al. Cálcio ionizado no soro: estimativa do intervalo de referência e condições de coleta. J Bras Patol Med Lab. 2004;40(2):85–9.CrossRefGoogle Scholar
  22. 22.
    Koletzko B. Pediatric nutrition in practice. Switzerland: Karger; 2008. p. 85–9.CrossRefGoogle Scholar
  23. 23.
    Kao PC. Parathyroid hormone assay. Mayo Clin Proc. 1982;57(9):596–7.PubMedGoogle Scholar
  24. 24.
    Dorsey JG. Introduction to modern liquid chromatography. J Am Chem Soc. 2010;132:9220.CrossRefGoogle Scholar
  25. 25.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.CrossRefPubMedGoogle Scholar
  26. 26.
    Chakhtoura M, Nassar A, Arabi A, et al. Effect of vitamin D replacement on maternal and neonatal outcomes: a randomised controlled trial in pregnant women with hypovitaminosis D. A protocol. BMJ. 2016;6(3):01–10.Google Scholar
  27. 27.
    Looker AC, Pfeiffer CM, Lacher DA, et al. Serum 25-hydroxyvitamin D status of the US population: 1988–1994 compared with 2000–2004. Am J Clin Nutr. 2008;1519–27.Google Scholar
  28. 28.
    Vimaleswaran KS, Berry DJ, Lu C, et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10:e1001383.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Schafer AL. Vitamin D and intestinal calcium transport after bariatric surgery. J Steroid Biochem Mol Biol. 2016;173:202–10. Scholar
  30. 30.
    Slusher AL, McAllister MJ, Huang C-J. A therapeutic role for vitamin D on obesity-associated inflammation and weight-loss intervention. Inflamm Res. 2015;64:565–75.CrossRefPubMedGoogle Scholar
  31. 31.
    Clare G, Royce V, Simon J. High prevalence of vitamin D insufficiency in a United Kingdom urban morbidly obese population: implications for testing and treatment. Surg Obes Relat Dis. 2014;10:355–60.CrossRefGoogle Scholar
  32. 32.
    Carlim AM, Sudhaker R, Meslemani M, et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis. 2006;2:98–103.CrossRefGoogle Scholar
  33. 33.
    National Institute for Health and Clinical Excellence. Antenatal care (NICE clinical guideline 62). Available, 2010.
  34. 34.
    Paxton GA, Teale GR, Nowson CA, et al. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement. Med J Aust. 2013;198:142–3.CrossRefPubMedGoogle Scholar
  35. 35.
    Gernand AD, Simhan HN, Caritis S, et al. Maternal vitamin D status and small-for-gestational-age offspring in women at high risk for preeclampsia. Obstet Gynecol. 2014;123:40–8.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Tabesh M, Salehi-Abargouei A, Tabesh M, et al. Maternal vitamin D status and risk of pre-eclampsia: a systematic review and meta-analysis. Clin Endocrinol Metab. 2013;98:3165–73.CrossRefGoogle Scholar
  37. 37.
    Jia X, Gu Y, Groome LJ, et al. 1,25(OH)2D3 induces placental vascular smooth muscle cell relaxation by phosphorylation of myosin phosphatase target subunit 1Ser507: potential beneficial effects of vitamin D on placental vasculature. Biol Reprod. 2016.Google Scholar
  38. 38.
    Medeiros M, Matos AC, Pereira SE, et al. Vitamin D and its relation with ionic calcium, parathyroid hormone, maternal and neonatal characteristics in pregnancy after Roux-en-Y gastric bypass. Arch Gynecol Obstet. 2015;293:539–47.CrossRefPubMedGoogle Scholar
  39. 39.
    Navarro G, Pereira JL, Serrano Aguayo P, et al. Maternal and fetal outcomes in pregnancy following bariatric surgery. Nutr Hosp. 2011;26(2):376–83.Google Scholar
  40. 40.
    Karlsson T, Andersson L, Hussain A, et al. Lower vitamin D status in obese compared with normal-weight women despite higher vitamin D intake in early pregnancy. Clin Nutr. 2014.Google Scholar
  41. 41.
    Misra A, Bhatt SP, Nigam P, et al. Independent associations of low 25 hydroxy vitamin D and high parathyroid hormonal levels with nonalcoholic fatty disease in Asian Indians residing in North India. J Atheroscler. 2013.Google Scholar
  42. 42.
    Compher CW, Badellino KO, Boullata JI. Vitamin D and the bariatric surgical patient: a review. Obes Surg. 2008;18:220–4.CrossRefPubMedGoogle Scholar
  43. 43.
    Cordeiro A, Santos A, Bernardes M, et al. Vitamin D metabolism in human adipose tissue: could it explain low vitamin D status in obesity? Horm Mol Biol Clin Invest. 2017;18(2):33.Google Scholar
  44. 44.
    Heslehurst N, Simpson H, Ells LJ, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9(6):635–83.CrossRefPubMedGoogle Scholar
  45. 45.
    McClure CK, Catov JM, Ness R, et al. Associations between gestational weight gain and BMI, abdominal adiposity, and traditional measures of cardiometabolic risk in mothers 8 y postpartum. Am J Clin Nutr. 2013;98(5):1218–25.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Ying VW, Kim SH, Khan KJ, et al. Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies. Surg Endosc. 2015;29:1018–23.CrossRefPubMedGoogle Scholar
  47. 47.
    Fleet JC. Molecular mechanisms for regulation of intestinal calcium and phosphate absorption by vitamin D. In: Feldman D, editor. Vitamin D. Vol 1. 3rd ed. Elsevier Academic press; 2011. p. 349–62.Google Scholar
  48. 48.
    Wagner CL, Taylor SN, Dawodu A, et al. Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients. 2012;4:208–30.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of MedicineFederal University of Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  2. 2.Center for Research on Micronutrients (NPqM)Institute of Nutrition Josué de Castro of UFRJRio de JaneiroBrazil
  3. 3.Federal University Fluminence (UFF)NiteróiBrazil
  4. 4.Center for Research on Micronutrients (NPqM)Federal University of Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  5. 5.Multidisciplinary Center for Bariatric and Metabolic SurgeryRio de JaneiroBrazil
  6. 6.Federal University of São Paulo (UNIFESP)São PauloBrazil
  7. 7.Brazilian Society of Bariatric and Metabolic SurgerySão PauloBrazil
  8. 8.ENSP/FIOCRUZRio de JaneiroBrazil
  9. 9.Department of Social and Applied Nutrition, Institute of NutritionFederal University of Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  10. 10.Institute of Nutrition Josué de CastroFederal University of Rio de Janeiro (UFRJ)Rio de JaneiroBrazil

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