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Bariatric surgery and pregnancy

Surgery between pregnancies lowers risks, improves outcomes

326 who had primary bariatric surgery between their first and second pregnancy were compared with 461,917 women who had a first and second pregnancy without surgery

Women who undergo bariatric surgery between a first and second pregnancy have lower risks of obesity‐related adverse pregnancy outcomes such as hypertension and pre-term birth in a subsequent pregnancy, according to researchers from New South Wales, Australia.

The study, ‘Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study’, published in BJOG: An International Journal of Obstetrics and Gynaecology, identified the population of women having surgery and compared the pregnancy outcomes in the surgical group vs a non-surgical group having a first and second pregnancy.

The authors reported that there was a 13‐fold increase in hospitalisations for primary bariatric surgery during 2002–2014. The rates of diabetes and hypertension were 8.2 and 3.0%, among bariatric admissions, and 99.5% had a recorded diagnosis of obesity.

There were 1,914 pregnancies among 1,484 women with 1,971 births in women who had bariatric surgery (median interval between bariatric surgery and conception was 2.1 years). A total of 486 (25.4%) pregnancies were within 12 months after surgery. The authors reported lower rates of hypertension (11.7 vs 15.6%, p=0.036) and admission to NICU/SCN (15.8 vs 19.9%, p=0.044) in this group vs pregnancies occurring 12 months after surgery.

The rates of smoking, diabetes, and hypertension were 11.9, 13.6, and 14.6%, respectively. Of the the 1971 births, 220 (11.2%) were born pre-term and 252 (12.8%) were delivered by pre-labour caesarean section. The overall perinatal mortality rate was 8.1/1000 and the stillbirth rate was 6.6/1000 total births.

Three hundred and twenty-six women who had primary bariatric surgery between their first and second pregnancy were compared with 461,917 women who had a first and second pregnancy without surgery. On average, both groups of women were of similar age at their first pregnancy; however, the bariatric group had their second pregnancy on average two years later than the non‐bariatric group. Furthermore, there were higher odds of in vitro fertilisation procedures and multiple births in the bariatric group in the first and second pregnancies.

Diabetes and hypertension rates were higher in the bariatric group in both first and second pregnancies. In the second pregnancy, there was a 67% reduction in the odds of pregnancy hypertension in the bariatric group vs a 49% reduction in the non‐bariatric group. Furthermore, there was a 39% increase in the odds of gestational diabetes in the second pregnancy among the non‐bariatric group vs a 24% decrease in the bariatric group, although this was not statistically significant.

The investigators also reported higher odds of severe maternal morbidity in the first pregnancy for women in the bariatric group, and maternal readmission rates within six weeks post-partum were higher in the bariatric group for first and second pregnancies.

Preterm birth rates were higher in the bariatric group in first pregnancies, in second pregnancies there was a 63% reduction in the odds of spontaneous preterm birth in the bariatric group compared with a 20% reduction in the non‐bariatric group. In the bariatric group, the odds of having an large for gestational age infant were higher in the first pregnancy; however, there was a 37% reduction in odds by the second pregnancy compared with a 74% increase in odds of large for gestational age in the non‐bariatric group.

“The odds of adverse pregnancy outcomes among women who have bariatric surgery do not decrease to the level observed in the general birthing population; however, there was substantial improvement,” the authors concluded. “Although BMI was not directly assessed in this study, bariatric surgery performed for the management of obesity, in accordance with current clinical criteria, is likely to result in improved pregnancy outcomes in women who have a subsequent pregnancy.”

To access this paper, please click here

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