Women with history of bariatric surgery have lower weight gain during pregnancy
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Key takeaways:
- Women with a history of bariatric surgery gained less weight during pregnancy vs. those with similar BMI entering pregnancy.
- Weight gain did not differ by surgical procedure.
Women who underwent bariatric surgery gained less weight during pregnancy compared with matched controls, and weight gain was lower in those who conceived shortly after surgery, according to data in JAMA Network Open.
“Previous studies have found that women with a history of bariatric surgery, compared with those without such a history but otherwise similar presurgery characteristics, had lower risk of gestational diabetes, preeclampsia, large-for-gestational age birth and cesarean delivery, whereas the risks of small-for-gestational age and preterm birth were higher,” Huiling Xu, MD, MSc, of the division of clinical epidemiology at Karolinska Institute, and colleagues wrote. “However, the association of bariatric surgery with postoperative pregnancy weight gain is not well-established.”
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They continued: “Furthermore, the impact of time and/or weight loss between the bariatric surgery and conception on postoperative pregnancy weight gain is unclear.”
In a nationwide, population-based, matched cohort study, Xu and colleagues evaluated data from 12,776 pregnancies to compare weight gain among women with a history of bariatric surgery (n = 6,388; mean age, 31.6 years) vs. without (n = 6,388; mean age, 31.4 years). Researchers also investigated whether weight gain differed by procedure type (sleeve gastrectomy = 890; gastric bypass = 890), surgery-to-conception interval and/or surgery-to-conception weight loss.
Propensity score matching was performed according to early-pregnancy BMI, pre-pregnancy diabetes and hypertension, maternal age, smoking status, education level, height, country of birth and delivery year. Researchers noted the early-pregnancy mean BMI was 29.4 among both groups.
Compared with matched controls, women with a history of bariatric surgery had lower pregnancy weight gain, with the greatest differences among women with normal or overweight early-pregnancy BMI.
The z-score differences between the two groups were –0.33 (95% CI, –0.43 to –0.23) for those with normal weight, –0.33 (95% CI, –0.4 to –0.27) for overweight, –0.21 (95% CI, –0.29 to –0.13) for obesity class I, –0.16 (95% CI, –0.29 to –0.03) for obesity class II and –0.08 for obesity class III. Xu and colleagues noted similar weight gain regardless of surgical procedure type and “across all early pregnancy BMI categories.”
Further, researchers reported that women who conceived within 1 year of surgery had the lowest weight gain, which increased until 2 years after surgery and stabilized 4 to 10 years after surgery. There also was a positive association between surgery-to-conception weight loss and pregnancy weight gain for every BMI category except obesity class III.
“Women with a history of bariatric surgery gained less weight during pregnancy than those with similar BMI entering pregnancy, which may be attributable to physiological effects of altered anatomy and gut hormones, thereby reducing food intake and appetite,” Xu and colleagues wrote. “The highest proportion of weight gain below the recommendations was found among women with a normal weight status. Hence, clinical attention to women with history of bariatric surgery and a normal weight status in early pregnancy might be warranted.”
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