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Risk for maternal, newborn complications lower for women who underwent bariatric surgery
Analysis revealed lower rates of gestational diabetes, preeclampsia and maternal weight gain.
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Findings from a new systematic review of published studies suggested that rates of adverse outcomes for mothers, pregnant women and newborns, such as gestational diabetes and microsomia, may be lower after bariatric surgery.
Researchers conducted a review of articles on bariatric surgery among women of reproductive age to estimate the incidence of bariatric surgery and to assess associations between surgery and pregnancy outcomes. After searching the Nationwide Inpatient Sample (1998-2005) and electronic databases such as Cochrane, Medline and EMBASE, the researchers identified the results of 75 studies that included pregnancy outcomes and fertility after bariatric surgery and were published between 1985 and 2008.
Analysis revealed an 800% increase in the incidence of bariatric surgery in the United States between 1998 and 2005, from 12,480 cases to 113,500 cases. Women aged 18 to 45 years accounted for 49% of procedures, and between 2003 and 2005, more than 50,000 women in this age group underwent inpatient bariatric surgery procedures annually.
The researchers said the study was conducted because “rates of surgical weight loss procedures have grown steeply and women account for many of these patients. Large numbers of women in their childbearing years may undergo bariatric surgery, which may change fertility following weight loss, alter nutritional requirements during pregnancy or impact contraception to prevent pregnancy.”
A review of several studies revealed lower maternal complication rates after bariatric surgery than in obese women who did not undergo bariatric surgery. In one study, rates of gestational diabetes (0% vs. 22.1%; P<.05) and preeclampsia (0% vs. 3.1%; P<.05) were lower among women who underwent laparoscopic adjustable gastric band surgery compared with obese women who did not. Maternal weight gain was also reduced in the surgery group.
Newborn outcomes were similar or better after bariatric surgery compared with obese women who did not undergo surgery: 7.7% vs. 7.1% for premature delivery; 7.7% vs. 10.6% for microsomia; and 7.7% vs. 14.6% for macrosomia (P<.05 for all).
“Research is needed to better delineate the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes. Optimizing success for contraception and producing healthy neonates following surgery will require a multidisciplinary effort by surgeons, primary care physicians, reproductive fertility specialists, obstetricians and patients,” the researchers wrote. – by Katie Kalvaitis
JAMA. 2008;300:2286-2296.
The most important take-home message is that pregnancy after bariatric surgery is safe, which is something many patients worry about. There is a general concern that anything that could interfere with good nutrition during pregnancy, such as bariatric surgery, may be problematic. For example, if a women doesn't eat enough or absorb food the same way she used to or can't get the same nutrition as before surgery it might cause issues for both the mother and baby. Although we still have to be careful about good nutrition, it does appear, based on this study, that bariatric surgery does not cause problems for mother or child. In fact, babies born to mothers who have had bariatric surgery may even be healthier than children born to obese mothers who have not had surgery. We still don't know much about the impact of bariatric surgery on fertility. There is some evidence that fertility is better after surgery; many women who suffer from obesity have trouble getting pregnant for various reasons. But we are still waiting for these data to come out. The other question is the timing of pregnancy after surgery. There seems to be evidence that pregnancy in the first year after surgery is safe, but there may be some premature birth during the first year. We need more evidence and until that evidence comes in, I recommend that my patients avoid getting pregnant until at least a year after bariatric surgery and their weight loss has stabilized.
– Andrew S. Wright, MD
Assistant Professor of Surgery, University of Washington