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Bariatric surgery and childbirth

Bariatric surgery linked to safer childbirth for the mother

1 percent of all babies born in Sweden have mothers who have had bariatric surgery

Mothers with obesity who lose weight through bariatric surgery can have safer childbirth including fewer caesarean sections, infections, tears and haemorrhages, and fewer cases of post-term delivery or uterine inertia according to an observational study by researchers at Karolinska Institutet in Sweden.

"We know that obesity and overweight are dangerous in connection with childbirth," said Dr Olof Stephansson, obstetrician and researcher at Karolinska Institutet's Department of Medicine in Solna. "Bariatric surgery is by far your best option if you want a lasting weight reduction over time."

In Sweden, more than one in every three women admitted into prenatal care either have obesity or are overweight, and statistics from the National Board of Health and Welfare show that this is a rising trend.

This paper, ‘Delivery outcomes in term births after bariatric surgery: Population-based matched cohort study’, published in PLOS Medicine, deliveries in 1,431 women who had achieved considerable weight loss after bariatric surgery and compared them with deliveries in 4,476 women who had not undergone surgery.

The main outcomes reported mode of delivery, induction of labour, post-term pregnancy (≥42+0 gestational weeks), epidural analgesia, foetal distress, labour dystocia, peripartum infection, obstetric anal sphincter injury (perineal tear grade III–IV) and postpartum haemorrhage.

"The effects were quite salient, and all of those we studied were to the benefit of the women who'd had surgery," added Stephansson. "There are a lower proportion of C-sections, fewer induced deliveries, a lower proportion of post-term deliveries, less frequent epidurals, and fewer cases of uterine inertia, infection, perineal tears and haemorrhaging."

Among the women with a history of bariatric surgery, the mean pre-surgery BMI was 42.6, the median surgery-to-conception interval was 1.4 years, and the mean BMI loss between surgery and early pregnancy was 13.5 (38kg). Compared to matched control women, post-surgery women were less likely to have caesarean delivery (18.2% vs. 25.0%), especially emergency caesarean (6.8% vs. 15.1%,). Post-surgery women also had lower risks of instrumental delivery (5.0% vs.6.5%), induction of labour (23.4% vs. 34.0%), post-term pregnancy (4.2% vs. 10.3%), obstetric anal sphincter injury (1.5% vs. 2.9%), and postpartum haemorrhage (4.6% vs. 8.0%,).

"Today, 1 percent of all babies born in Sweden have mothers who have had bariatric surgery. It might not sound many, but this number is rising. When the women start to lose weight, their fertility quickly recovers, so this, too, is improved by the operation,” concluded Stephansson. "It's therefore not as simple as just advising every woman who's overweight to have bariatric surgery. But going by the results of this study, it has positive effects for mothers. More studies are needed in which we weigh up outcomes so that we can give a more general recommendation."

To access this paper, please click here

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