Bariatric Surgery in Women of Childbearing Age, Timing Between an Operation and Birth, and Associated Perinatal Complications

Parent, Brodie; Martopullo, Ira; Weiss, Noel S.; Khandelwal, Saurabh; Fay, Emily; Rowhani-Rahbar, Ali

doi:10.1001/jamasurg.2016.3621

Cited by 117 publications

(90 citation statements)

References 36 publications

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“…The early conception rate reported in our study of 42.3/1,000 woman-years in the 18 month post-surgical window is especially concerning given recent findings that bariatric surgery increases the risk of SGA infants, preterm deliveries and NICU admissions in the first two years after surgery. 5,29 Our findings highlight a public health concern that merits additional scrutiny regarding contraceptive counseling and provision of services for all reproductive age women undergoing bariatric surgery. Guidelines recommending inclusion of referral for counseling for post-operative contraceptive use as part of the preoperative evaluation would be prudent.…”

Section: Discussionmentioning

confidence: 76%

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Contraception and Conception After Bariatric Surgery

Menke

King

White

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To examine contraceptive practices and conception rates after bariatric surgery. Methods The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual post-surgical assessments for up to seven years until January 2015. This report was restricted to women 18–44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate and early (<18 months) post-surgical conception. Contraceptive practice (no intercourse, protected, unprotected, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies. Results Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (IQR) preoperative age was 34 (30–39) years. In the first postsurgical year, 12.7% (95%CI, 9.4–16.0) of women had no intercourse, 40.5% (95%CI, 35.6–45.4) had protected intercourse only, 41.5% (95%CI, 36.4–46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95%CI, 2.4–6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95%CI, 9.3–17.0; P<0.001). The conception rate was 53.8 (95%CI, 40.0–71.1) per 1,000 woman-years across follow-up (median [IQR]: 6.5 [5.9, 7.0] years); 42.3 (95%CI, 30.2–57.6)/1,000 woman-years in the 18 months after surgery. Age (ARR 0.41, [95% CI, 0.19–0.89] per 10 years, P=0.03), being married or living as married (ARR 4.76, [95% CI, 2.02–11.21], P<0.001), and rating future pregnancy as important preoperatively (ARR 8.50, [95% CI, 2.92–24.75], P<0.001) were associated with early conception. Conclusion Post-surgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery. Clinical Trial Registration ClinicalTrials.gov, NCT00465829.

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Section: Discussionmentioning

confidence: 76%

“…The delay is intended to optimize the likelihood of maternal weight stability during fetal growth. This recommendation precedes recent evidence suggesting conception within two years of bariatric surgery increases the risk for prematurity, small for gestational age (SGA) infants, and neonatal intensive care unit (NICU) admissions 5 .…”

Section: Introductionmentioning

confidence: 89%

Contraception and Conception After Bariatric Surgery

Menke

King

White

et al. 2017

Obstetrics &Amp; Gynecology

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“…However, there are concerns with regard to conceiving during the period of rapid weight loss seen in the first 12-24 months following bariatric surgery, as this period has been associated with higher rates of nutritional deficiencies and obstetric complications [99]. In a multicentre study from Spain including 168 pregnancies in 112 women, a higher stillbirth rate was seen in pregnancies occurring in the first year post-surgery [100].…”

Section: Pregnancy After Bariatric Surgerymentioning

confidence: 99%

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

et al. 2017

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Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

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“…For example, Abenhaim et al used hospital discharge data, did not describe birth defect inclusion criteria, and reported less than one per cent of exposed and unexposed infants as having a birth defect . In contrast, Parent et al defined birth defects as any malformation diagnosis on the birth certificate or delivery discharge diagnoses (International Classification of Diseases codes 740‐756, excluding chromosomal abnormalities) and reported 22% and 16% of infants were affected in the exposed and unexposed groups, respectively . Moreover, the majority of studies lacked details regarding the definition and ascertainment of birth defects, such as the specific pregnancy outcomes (eg, livebirths, foetal deaths, terminations) that were included in the study, the time frame for ascertainment of birth defects (eg, at birth, through age 1 year), specific exclusion criterion (eg, syndromes) and verification procedures (eg, clinical review).…”

Section: Resultsmentioning

confidence: 99%

Bariatric surgery and birth defects: A systematic literature review

Benjamin

Littlejohn

Mitchell

2018

Paediatric Perinatal Epid

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Background: Bariatric procedures are on the rise. The risk of birth defects in pregnancies following such procedures may be increased (e.g. due to nutrient deficiencies) or decreased (e.g. due to decreased maternal body mass index, BMI). Methods: We conducted a systematic literature review of the association between bariatric surgery and birth defects using Ovid MEDLINE and PubMed (1946-2017). Information was abstracted on study design, exposures, outcomes, covariates, and estimates of association. Results: Fifteen studies met our inclusion criteria; 14 evaluated the outcome of any birth defect and one evaluated neural tube defects. Estimates of association between bariatric surgery and birth defects were available for nine studies and ranged from 0.6-1.9 (all 95% confidence intervals included 1.0). When studies were stratified by surgery type, there was no obvious pattern of association. When stratified by the approach used to account for BMI, positive associations were observed in studies that did not account for maternal prepregnancy BMI or used women with normal BMI as the reference group (range: 1.3-1.9). Estimates from studies that either matched or adjusted for prepregnancy BMI were closer to the null (range: 1.1-1.2) and studies that compared to morbidly obese women reported protective associations (range: 0.6-0.7). Conclusions: Studies of the association between bariatric surgery and birth defects vary with respect to the surgical procedures included, birth defects ascertainment methods, and approaches used to account for maternal BMI. Consequently, it is not possible to draw a conclusion regarding the association between bariatric surgery and birth defects. Additional studies are warranted.

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Bariatric Surgery in Women of Childbearing Age, Timing Between an Operation and Birth, and Associated Perinatal Complications

Cited by 117 publications

References 36 publications

Contraception and Conception After Bariatric Surgery

Contraception and Conception After Bariatric Surgery

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Bariatric surgery and birth defects: A systematic literature review

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