Data support avoiding pregnancy for 1 year after bariatric surgery
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Women who become pregnant in the year after bariatric surgery are more likely to experience higher rates of preterm birth and low birth weight compared with similar women who delayed pregnancy, a retrospective data analysis shows.
In an analysis of nearly 200 single pregnancies among mothers who underwent bariatric surgery, researchers found that women who became pregnant within 12 months after surgery were more likely to experience “inadequate” gestational weight gain, putting women at risk for neonatal complications.
“Pregnant women with obesity are often warned that they should not gain too much weight during pregnancy, as this may be harmful for themselves and the unborn child,” Laura Heusschen, MSc, a doctoral student at Vitalys Obesity Clinic, part of Rijnstate Hospital in Arnhem, Netherlands, told Healio. “However, the potential risks of inadequate weight gain during pregnancy might be even more pronounced, especially for women who underwent bariatric surgery.”
Current guidelines recommend avoiding pregnancy for 12 to 24 months after bariatric surgery because of active weight loss and an increased risk for nutritional deficiencies, Heusschen and colleagues wrote in a study published in Obesity Surgery. However, high-quality evidence is lacking, and only a few studies include data on gestational weight gain.
In a multicenter, retrospective study, Heusschen and colleagues analyzed data from 196 singleton pregnancies after Roux-en-Y gastric bypass, sleeve gastrectomy and one anastomosis gastric bypass. Pregnancies were divided into early ( 12 months), middle (12-24 months), and late (> 24 months) groups, according to the surgery-to-conception interval. Gestational weight gain was classified as inadequate, adequate or excessive, according to the National Academy of Medicine recommendations. Primary outcomes were gestational age at delivery, preterm birth (< 37 weeks), birth weight, weight-for-age percentile, large for gestational age and small for gestational age. Secondary outcomes were Apgar score less than 7 at 5 minutes, neonatal hospitalization, congenital effects and perinatal death. Findings were adjusted for maternal age, gravidity, smoking status, prepregnancy BMI and surgery type.
Researchers found that pregnancy in the early group (23.5%) was associated with a lower gestational age at delivery compared with pregnancy in the middle and late groups (mean, 267.1 days vs. 272.7 days and 273.1 days, respectively; P = .029). Pregnancy in the year after surgery was also associated with lower gestational weight gain (mean, –0.9 kg vs. 10.2 kg and 10 kg, respectively; P < .001), and lower neonatal birth weight (mean, 2,979 g vs. 3,161 g and 3,211 g, respectively; P = .008) compared with pregnancy in the middle and late groups.
Compared with adequate weight gain, inadequate gestational weight gain (40.6%) was associated with lower gestational age at delivery (mean, 266.5 days vs. 273.8 days; P = .002) and lower neonatal birth weight (mean, 3,061 g vs. 3,217 g; P = .053). There were no differences in other pregnancy and neonatal outcomes between groups.
Preterm births were also more frequently observed in this group (15.9% vs. 6%; P = .037).
“We should encourage women who wish to conceive after bariatric surgery to avoid pregnancy until their weight has stabilized to minimize the risk of inadequate gestational weight gain,” the researchers stated in a press release. “In order to break the vicious cycle of obesity and its health consequences, it is important that future research and clinical care focus on the prevention of babies being born small for gestational age after bariatric surgery.”
Reference:
Heusschen L, et al. Obes Surg. 2021;doi:10.1007/s11695-020-05219-3.
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Heusschen L, et al. EP3-23. Presented at: European Congress on Obesity Annual Meeting; May 10-13, 2021; (virtual meeting).
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