Title: Pregnancy after Two Different Modalities of Bariatric Surgery. What to Expect?

Authors: Mohamed A Youssry MD, Ahmed M Radwan MD

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.69

Abstract

Objective: to assess the maternal and neonatal risks of two different bariatric surgical procedures on the following pregnancy regarding obstetric complications and perinatal outcome.

Subject and Methods: In this retrospective cohort study, a total of forty four pregnant women underwent bariatric surgery and were followed up for antenatal care between 2014 and 2017 included in the study. According to the type of bariatric surgery they were sub-classified into two groups. Group (A) 28 pregnant women who had undergone restrictive procedure, and group (B) 16 pregnant women who had undergone malabsorptive procedure.

Results: The prevalence of abortion, and preterm labor was 15.9%, 6.8%, of the total participants, and no significant differences recorded between both groups (p=0.32, 0.078; respectively). Moreover, there were no statistically significant differences in the development of hypertensive disorders or gestational diabetes mellitus between both groups. Vitamin B12 and calcium deficiencies were significantly higher in group (B) compared to group (A) (P= 0.036, 0.025; respectively). Cesarean delivery was performed in 36.3% of the total participants, and it was significantly higher in group (B) compared to group (A) (61.5% vs. 33.3%, p=0.016). The mean birth weight, and Apgar score showed statistical insignificant differences between both groups, and no neonatal mortality recorded in either group.

Conclusion: Bariatric surgery is the most effective treatment of obesity and related morbidities particularly at reproductive age group. Pregnancy after bariatric surgery is safe for mother and fetus but micronutrient deficiency should be managed properly before pregnancy to prevent adverse outcome.

Keywords:  Bariatric surgery, perinatal outcome, Cesarean delivery.

References

  1. Edwards JE. Pregnancy after bariatric surgery. AWHONN Lifelines 2005; 9:  388–393.
  2. Allison DB , Fontaine K R, Manson J E , et al. Annual deaths attributable to obesity in the United States. Journal of the American Medical Association 1999; 282 : 1530-1538.
  3. Brockelsby and M.Dresner. Obesity and pregnancy. Current Anaesthesia & Critical Care 2006; 17:125–129.
  4. Ono T, Guthold R, Strong K. WHO Global Comparable Estimates. 2005 [https://apps.who.int/infobase/].
  5. Parihar M. Obesity and infertility. Reviews in Gynecological Practice.  2003;3:120–126.
  6. Balen AH, and Michelmore K. What is polycystic ovary syndrome? Are national views important?  Hum Reprod2002; 17: 2219-2227. 
  7. Nohr EA, Bech BH, Davies MJ, et al. Prepregnancy obesity and fetal death: a study within the Danish National Birth Cohort. Obstet Gynecol 2005;106:250–259.
  8. Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. J Am Med Assoc 2008; 300: 2286–2296.
  9. National Institute for Health and Clinical Excellence, National Collaborating Centre for Primary Care. Obesity: the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. London: NICE; 2006.
  10. Nelson SM, and Fleming R. Obesity and reproduction: impact and interventions. Curr Opin Obstet Gynecol. 2007;19:384-389.
  11. Teitelman M, Grotegut CA, Williams NN, Lewis JD. The impact of bariatric surgery on menstrual patterns. Obes Surg 2006;16:1457-1463.
  12. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish subjects. N Eng J Med 2007;357:741–752.
  13. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstetrics & Gynecology ;2009 :113. 1405–1413.
  14. Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol. 2004;103:452–456.
  15. Chu SY, Kim SY, Schmid CH, et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007;8:385–394.
  16. 16- Johansson K, Cnattingius S, Näslund I, et al. Outcomes of pregnancy after bariatric surgery. N Eng J Med. 2015;372: 814–824.
  17. American College of Obstetricians and Gynaecologists. ACOG Committee opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol 2005;106:671–675.
  18. Woodard BC. Pregnancy following bariatric surgery. Journal of Perinatal and Neonatal Nursing 2004:18:329–340.
  19. Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update 2009; 15:189–201.
  20. Skull AJ, Slater GH, Duncombe JE, Fielding GA. Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes. Obes Surg 2004; 14:230-235.
  21. Patel JA, Patel NA, Thomas RL, Nelms JK, Colella JJ. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008;4:39–45.
  22. Wax JR, Cartin A, Wolf R, Lepich S, Pinette MG, Blackstone J. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg 2008;18:1517–1521.
  23. González I, Rubio MA, Cordido F, et al. Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obse Surg 2015;25:436–442.
  24. Kjaer MM, Lauenborg J, Breum BM, Nilas L. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol 2013;208: 464.e1–e5.
  25. Sheiner E, Balaban E, Dreiher J, Levi I, Levy A. Pregnancy outcome in patients following different types of bariatric surgeries. Obes Surg 2009;19:1286–1292.
  26. Aricha-Tamir B, Weintraub Y, Levi I, Sheiner E. Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery. Surg Obes Relat Dis 2012;8:434–439.
  27. Dao T, Kuhn J, Ehmer D, Fisher T, McCarty T. Pregnancy outcomes after gastricbypass surgery. Am J Surg 2006;192:762–766.
  28. Sheiner E, Edri A, Balaban E, Levi I, Aricha-Tamir B. Pregnancy outcome of patients who conceive during or after the first year follow­ing bariatric surgery. Am J Obstet Gynecol 2011;204(1):50.e1–e6.
  29. Cafaro l, González C,   Andreoni M, et al.. Pregnancy after Roux-en-Y Gastric Bypass. Bariatric Times 2016;13:14–18
  30. Wang JX, David MJ, Norman RJ. Obesity increases the risk of spontaneous abortion during infertility treatment. Obes Res 2002; 10:551–554.
  31. Lashen H, Fear K, Sturdee DW. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod 2004;19:1644–1646.
  32. Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproduc­tive outcome for all forms of fertility treatment. Hum Reprod 1998;13:1502–1505.
  33. Bilenka B, Ben-Shlomo I, Cozacov C, Gold CH, Zohar S. Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity. Acta Obstet Gynecol Scand 1995;74:42–44.
  34. Friedman D, Cuneo S, Valenzano M, et al. Pregnancies in an 18-year follow-up after biliopancreatic diversion. Obes Surg 1995;5:308–313.
  35. Pilone V, Hasani A, Di Micco R,et al. Pregnancy after laparoscopic gastric banding: maternal and neonatal outcomes. Int J Surg 2014;12 Suppl 1:S136-9. doi: 10.1016/j.ijsu.2014.05.027. Epub 2014 May 24.
  36. Bebber FE, Rizzolli J, Casagrande DS, et al. Pregnancy after bariatric surgery: 39 pregnancies follow-up in a multidisci-plinary team. Obes Surg 2011;21:1546–1551.
  37. Kjaer MM. and Nilas L. Pregnancy after bariatric surgery—a review of benefits and risks. Acta Obstetricia et Gynecologica Scandinavica, 2013;92:264-271.
  38. Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obesity Surgery 2008;18: 1023–1027.
  39. Decker GA, Swain JM, Crowell MD, Scolapio JS.Gastrointestinal and nutritional complications after bariatric surgery. American Journal of Gastroenterology 2007;102 : 2571–2580.
  40. Bennett WL, Gilson MM, Jamshidi R, et al. Impact of bariatric sur­gery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data. BMJ. 2010;340:c1662.
  41. Galazis N, Docheva N, Similis C, Nicolaides KH. Maternal and neo­natal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014;181:45–53.
  42. Josefsson A, Blomberg M, Bladh M, Frederiksen SG, Sydsjö G. Bar­iatric surgery in a national cohort of women: sociodemographics and obstetric outcomes. Am J Obstet Gynecol 2011;205:206.e1–e8.
  43. Young TK, and Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: the importance of pre-pregnancy body mass index and weight gain. Am. J. Obstet. Gynecol 2002; 187:312-318.

Corresponding Author

Mohamed A Youssry MD   

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Mobile: +966542958651, +966565621679, Fax: +966122682888