Although outcomes are generally good, nutritional and surgical complications can arise. Further research should consider a greater role for bariatric surgery in improved pregnancy outcomes along with the longterm impact on offspring. This chapter addresses issues that occur in reproductive age women either planning a pregnancy or pregnant after bariatric surgery. Does bariatric surgery affect the risk of adverse outcomes in.
Objectives to estimate bariatric surgery rates among women aged 18 to 45 years and to assess the published literature on. Impact of bariatric surgery on fetal growth restriction american. Although pregnancy outcomes generally have been favorable after bariatric surgery, nutritional and surgical complications can occur and some of these complications can. Pregnancy care for women after bariatric surgery a. A metaanalysis of maternal and fetal outcomes of pregnancy. Context use of bariatric surgery has increased dramatically during the past 10 years, particularly among women of reproductive age objectives to estimate bariatric surgery rates among women aged 18 to 45 years and to assess the published literature on pregnancy outcomes and fertility after surgery. Nov 25, 2019 women with obesity who become pregnant after bariatric surgery have a reduced risk of several obstetric complications. Pdf maternal obesity is a major cause of obstetric morbidity and mortality. Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes. Nutritional and perinatal outcomes of pregnant women with. Challenges and benefits of bariatric surgery before pregnancy although obesity has become a major health care problem. Pregnancies after bariatric surgery, as compared with matched control pregnan cies, were.
In recent years, several studies have reported that maternal and perinatal outcomes of pregnancies occurring earlier than 1218 months after bs were not inferior. Pregnancy after bariatric surgery and adverse perinatal outcomes. Bariatric surgery bs is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. General recommendations advocates46 for a prudent waiting period of at least two years after bs to become pregnant. This interval was chosen since the usual duration of the initial period in which a significant and rapid weight loss occurs, and the potential risk of developing nutritional deficiencies is increased, is approximately 1224 months. The authors used administrative claims data from 7 large.
To measure the incidence of contemporary bariatric surgery procedures in women age 1845 and to assess its impact on fertility, contraception, prepregnancy risk factors, and pregnancy outcomes, including those of neonates. To compare pregnancy outcomes postbariatric surgery for women who remain obese at conception to those who were not obese. The effects of bariatric surgery bs on outcomes in subsequent pregnancies are unclear. However, this study was also associated with negative outcomes, including an increased risk for smallforgestational age infants and possibly increased mortality. Retrospective study of pregnant women hospitalized for delivery in the maternity in curitiba, brazil, who had a body mass index bmi greater than or equal to 30 kgm2 andor who had undergone bariatric surgery. Pregnancy outcome following bariatric surgery khan 20 the. Pregnancy and fertility following bariatric surgery. To estimate the rates of pregnancy outcomes of women after bariatric surgery relative to women in a control groups. Regarding certain complications, pregnancy after bariatric surgery appears to be safer than pregnancy in the obese.
Nutritional and perinatal outcomes of pregnant women with a. To compare maternal and fetal outcomes among women who become pregnant after bs and obese women who have not undergone bs before pregnancy. Bariatric surgery was linked to positive outcomes in pregnancy, such a reduced risk for gestational diabetes and excessive fetal growth, according to data from a populationbased study. Similar outcomes were seen between the 2 groups regarding fetal weight, term pregnancy, and complications. Despite referrals to a family planning clinic, a fair number become pregnant within that timeframe o2 yr. Results concerning the incidence of preterm delivery and the number of csections are less consistent. Outcomes of pregnancy after bariatric surgery request pdf. A considerable number of women undergoing bs are at childbearing age.
Pregnancy outcomes in women after bariatric surgery compared with obese and morbidly obese controls. Although pregnancy outcomes generally have been favorable after bariatric surgery, nutritional and surgical complications can occur and some of these complications can result in adverse perinatal outcomes. Weight regain is normal and expected, occurring most often in years 2 to 6 after surgery. A metaanalysis of maternal and fetal outcomes of pregnancy after bariatric surgery author links open overlay panel xiaoyan yi a qifu li a jun zhang b zhihong wang a show more. Outcomes of pregnancy after bariatric surgery nejm. Fiveyear kidney outcomes of bariatric surgery differ in. Another challenging clinical question is whether it is better to have bariatric surgery first then pregnancy, or delay bariatric surgery until. Retrospective study of pregnant women hospitalized for delivery in the maternity in curitiba, brazil, who had a body mass index bmi greater than or equal to 30 kgm 2 andor who had undergone bariatric surgery. Bariatric surgery is popular among morbidly obese women of child bearing age. A retrospective, descriptive, observational study of 39 pregnant women who underwent bs in our institution between 2010 and 2014 was carried out. Preparing for and managing a pregnancy after bariatric surgery.
Of 2,423 patients who had undergone bariatric surgery from 2001 to 2004, 21 patients became pregnant within the first year after surgery and became pregnant after 1 year. Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse. Pregnancy outcomes after bariatric surgery there is now evidence that bariatric surgery performed before pregnancy is not only associated with several bene. Context use of bariatric surgery has increased dramatically during the past 10 years, particularly among women of reproductive age. Bariatric surgery has been shown to be the most effective longterm weight loss strategy in obese women in this age group. From a database of women who received outpatient perinatal services, we identified women with a history of bariatric surgery who are currently pregnant with a singleton gestation. Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as.
Interviews were performed, and the patients medical records and antenatal information cards were. Maternal obesity is a major cause of obstetric morbidity and mortality. A systematic search of available literature was performed, and the adapte protocol for guideline development. Contraceptive counseling adolescents fastest growing group undergoing bariatric surgery and twice as.
Pregnancy after bariatric surgery the effect of timeto. We decided to investigate pregnancy outcomes in these patients compared with outcomes in patients who become pregnant after the 2year period. Does bariatric surgery affect the risk of adverse outcomes. Pregnancy after bariatric surgery and adverse perinatal. Weightloss surgery and pregnancy complications webmd. When possible, the difference in effect size between malabsorptive and restrictive procedures was explored. Recently, new diagnostic criteria for gdm following the international association of diabetes and pregnancy study group recommendations were implemented.
To evaluate the impact of bariatric surgery on the gestational outcomes. Life after bariatric surgery is not all easy, but strong planning, appropriate education, and determination can help as you make this journey. Pregnancy after weightloss surgery obesity action coalition. The risk of adverse pregnancy outcome after bariatric surgery.
Pregnancy outcomes after all types of weightloss surgery even the problematic old intestinal bypass operations and the complex modern aggressive operations with the ability to cause deficiencies and other nutritional problems are universally safer and better than outcomes of pregnancies with obesity. Bariatric surgery can lead to complications during pregnancy such as internal hernias, intestinal obstructions, hyperemesis, cholelithiasis and. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. The positive effects of bariatric surgery on health outcomes such as diabetes and cardiovascular disease are reasonably wellstudied, but less. The counseling and management of patients who become pregnant after bariatric surgery can be complex. Studies that have evaluate pregnancy outcomes after bs almost exclusively have included patients who underwent either gastric bypass ie.
Available maternal characteristics and pregnancy outcomes were. Few studies have assessed pregnancy outcomes following. Bariatric surgery and pregnancy protocol 3 third trimester most women remain obese after surgery and may require labor induction, more oxytocin and have longer labor than nonobese women. Pregnancy after bariatric surgery is safer, with fewer complications, than. Pregnancy outcome following bariatric surgery khan.
Presurgery and prepregnancy body mass index bmi were calculated for 70 patients who had. In light of the generally poor longterm outcomes of traditional weight loss techniques, bariatric surgery may be the most effective strategy to prevent gmd in obese women 9, despite the possibility of increased risk raised by some authors 7, 15, 29, 52. Christopher ibikunle, md, assistant professor of surgery at. Background and significance evidence exists that improving the knowledge of health care providers who are unaware of health care needs of women post bariatric surgery during pregnancy will improve the outcomes of post bariatric patients which may result in fewer pregnancy complications and. Bariatric surgery has been shown to improve many obesity related comorbidities, including gestational diabetes mellitus gdm. Pregnancy outcomes after bariatric surgery tend to approach those of the general obstetrical population. Does bariatric surgery lower the risk of an adverse outcome during pregnancy. We identified 73 pregnancies in 54 women who became pregnant after undergoing bariatric surgery. Special considerations are necessary in the management of a pregnancy after bariatric surgery. As most drugs used to lose weight have questionable efficacy, patients with obesity that is refractory unresponsive to these interventions are frequently advised to undergo bariatric surgery. Average weight outcomes for bariatric surgery are 20 to 30% loss of initial weight or a loss of 50 to 60% of excess weight. Maternal and neonatal outcomes for pregnancies before and. Pregnancy outcome of patients who conceive after bariatric.
We aimed to evaluate the impact of bariatric surgery bs on maternal and fetal outcomes. Emerging evidence suggests that bariatric surgery improves pregnancy outcomes of women with obesity by reducing the rates of gestational diabetes, pregnancyinduced hypertension, and macrosomia. Bariatric surgery is now increasingly recognized as an accepted treatment option for severe obesity that has beneficial effects on longterm obesityrelated comorbidities, including kidney disease. Bariatric surgery before pregnancy improves obesityrelated. Bariatric surgery should be considered as a riskmitigating step towards a achieving a healthy pregnancy and delivery, lead author a. Fiveyear kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes. Women with obesity who become pregnant after bariatric surgery have a reduced risk of several obstetric complications. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. Recommendations for preconception counseling and care.
Recommendations for preconception counseling and care narges farahi, md, and adam zolotor, md, drph. Taking presurgery bmi into account, this study aims to investigate the risks of adverse perinatal outcomes including gestational diabetes in women who. Clinicians should be aware of the effects of bariatric surgery on fertility and future pregnancies. Apr 01, 2010 counseling and treating women who become pregnant after bariatric surgery present unique challenges.
Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes 1. Though both the british obesity and metabolic surgery society and the american society for metabolic and bariatric surgery recommend that patients avoid pregnancy for 12 to 18 months after surgery to ensure a stable weight has been reached 1,2, the american college of obstetricians. Original article from the new england journal of medicine outcomes of pregnancy after bariatric surgery. Pregnancy outcomes in women after bariatric surgery. The present study aimed to characterise a case series of women who attended a medical antenatal clinic for pregnancy following bariatric surgery. Previous metaanalyses on pregnancy after bariatric surgery have focused on maternal outcomes, and there is limited evidence on perinatal outcomes other than size for gestational age and preterm birth 8,14. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mothers presurgery bodymass index bmi. Bariatric surgery before pregnancy lowers risk for. Commentary on a study on whether outcomes in pregnancy are affected by bariatric surgery, published april 2010 in bmj. Odds ratios were estimated with the use of logistic regression conditioned on the matching set one pregnancy after bariatric surgery and up to five controls matched for maternal age, parity. However, bs itself can be a risk factor for the development of adverse pregnancy outcomes and poses a challenge for obstetricians. Pregnancy care for women after bariatric surgery a clinical.
Pregnancy outcomes following bariatric surgery journal. Oct 12, 2012 bariatric surgery has been shown to be the most effective longterm weight loss strategy in obese women in this age group. Contributed by members of the american society for metabolic and bariatric surgery asmbs patient safety committee and public education committee. Counseling and treating women who become pregnant after bariatric surgery present unique challenges. Pregnancy after bariatric surgery appears to effectively reduce the risk of complications such as fetal macrosomia, gestational diabetes mellitus, and hypertensive disorders of pregnancy. The aim of the study was to determine the outcomes of pregnancy in the reproductive period among patients with previous surgery due to obesity.