Bariatric Surgery Improves Outcomes for
Mom, Infant

Donavyn Coffey

December 05, 2019

Bariatric surgery may improve obesity-related pregnancy and birth outcomes, a study has found.

Women who had bariatric surgery after their first pregnancy showed significant reductions in pregnancy hypertension, spontaneous preterm birth, a large-for-gestational-age neonate, and admission to the neonatal intensive care unit (NICU) with their second child. 

Ibinabo Ibiebele, PhD, MIPH, from the University of Sydney, Australia, and colleagues published their findings online November 28 in the British Journal of Obstetrics and Gynecology.

The researchers conducted a population-based study using hospital records for all women of reproductive age (15-45 years) in New South Wales and every woman who gave birth in New South Wales from 2002 to 2014. They compared female patients who underwent bariatric surgery with the general population of reproductive-aged women, and also investigated how the weight loss surgery affected pregnancy outcomes in the same women.

During the 12-year study period, hospital admission for bariatric surgery increased 13-fold in New South Wales — from 0.9 to 11.7 admissions per 10,000 women.

The trend in the United States is similar. Obesity rates in women of reproductive age are increasing in proportion with the rest of the population,  which has an obesity rate of 39.8%. Bariatric surgeries increased by 44% from 2011 to 2017, according to the American Society for Metabolic and Bariatric surgery, and based on the findings from a 2015 study approximately 80% of those surgeries are women.

There was a mean of 2 years between surgery and conception in the patients with bariatric surgery, but one fourth of the women conceived within 12 months of their operation. These women had even better outcomes — lower hypertension and admission to the NICU — than those who conceived more than 12 months after the surgery.

A total of 326 women — 99.5% of whom were obese — had bariatric surgery between their first and second pregnancy. Bariatric patients still had higher rates of hypertension and diabetes in their first and second pregnancy compared with the general population. But pregnancy hypertension was reduced by 67% between the first and second pregnancy when the women had weight-loss surgery. Spontaneous preterm birth rate was reduced by 63% in the second pregnancy for women who had bariatric surgery.

As a result of the prospective nature of the study data, certain data points, such as body mass index (BMI), are missing. The researchers point out that they were not able to make comparisons on the basis of presurgery BMI. Thus, bariatric patients were compared with a control population of obese and non-obese women, which may "underestimate the effect of bariatric surgery on pregnancy outcomes," the authors write.

Although bariatric surgery does not decrease the odds of "adverse pregnancy outcomes…to the level observed in the general birthing population," it may offer significant improvements for both mother and baby, the researchers conclude.

The study was supported by the New South Wales Ministry of Health Prevention Research Support Program. The study authors have disclosed no relevant financial relationships.

BJOG. Published online November 28, 2019. Full text

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