Pregnancy after bariatric surgery may lower risks for adverse pregnancy outcomes
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Pregnancy after receiving bariatric surgery was associated with decreased risks for preeclampsia, gestational diabetes or impaired fasting glucose and large for gestational age neonates, researchers reported in Obstetrics & Gynecology.
“The study adds to growing evidence of the safety of giving birth after weight-loss surgery while emphasizing the importance of nutritional guidance during pregnancy for these patients,” Monique M. Hedderson, PhD, research scientist and associate professor in the department of health systems science at Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, told Healio. “Pregnancies occurring after a bariatric surgery need to be monitored closely to make sure the women are getting adequate nutrition to ensure fetal growth.”
This retrospective cohort study included 1,591 women who had undergone bariatric surgery (mean age, 34 years) and gave birth from 2012 to 2018. Researchers identified bariatric surgery history using the ICD codes and a clinical database. The bariatric surgery cohort was matched with 7,955 women who gave birth and did not undergo such surgery with 6.5% at healthy weight, 22.2% who had overweight and 69.1% with obesity.
The primary outcome was preterm birth, gestational hypertension, preeclampsia, impaired glucose tolerance or gestational diabetes, large for gestational age or small for gestational age neonates and cesarean delivery.
Results demonstrated that pregnancy after bariatric surgery, compared with the non-surgery cohort, was associated with decreased risks for preeclampsia (7.5% vs. 10.2%; adjusted RR = 0.72; 95% CI, 0.6-0.86), gestational diabetes or IFG (23.5% vs. 35%; aRR = 0.73; 95% CI, 0.66-0.8) and large for gestational age infants (10.6% vs. 19.9%; aRR = 0.56; 95% CI, 0.48-0.65) and an increased risk for small for gestational age infants (10.9% vs. 6.6%; aRR = 1.51; 95% CI, 1.28-1.78) in multivariate models.
In addition, researchers observed no significant differences in rates of preterm birth, gestational hypertension and cesarean delivery.
“Further research on how patients who have had bariatric surgery can manage nutrition during their pregnancy will be important,” Hedderson said. “This study highlights the need for more detailed understanding of how the multiple factors that relate to both metabolic health and a healthy pregnancy interact.”
For more information:
Monique M. Hedderson, PhD, can be reached at monique.m.hedderson@kp.org.
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The authors present a retrospective cohort study from a large California database of 1,591 pregnancies after bariatric surgery and compare them to 7,955 pregnancies matched by propensity scores for pre-pregnancy BMI and several other variables. Of note, 23.5% and 67.3% of the post-bariatric surgery pregnancies had overweight and obesity,
respectively. Similar to prior cohort studies on this topic, there was a reduction in preeclampsia, gestational diabetes or impaired fasting glucose, and reduced risk for large for gestational age infants as well as an increased risk for small for gestational age infants in the adjusted analyses. There were also differences in gestational weight gain among the two cohorts.
The improvement in several important perinatal outcomes is reassuring, but several questions remain regarding risks related to pregnancies after bariatric surgery and their optimal management. For example, we need a greater understanding of the relationship between altered absorption of nutrients and fetal growth and long-term health outcomes of these offspring. Other questions include how to screen for gestational diabetes after bariatric surgery and the optimal time to conception after bariatric surgery.
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