Effect of bariatric surgery on maternal cardiovascular system

Abstract

Objective Bariatric surgery is a successful treatment for sustainable weight loss and has been associated with improvement in cardiovascular function. Pregnancy after bariatric surgery is becoming increasingly common; however, little is known about the maternal cardiovascular system postsurgery. The aim of this study was to investigate maternal cardiovascular adaptation to pregnancy in women with previous bariatric surgery, compared with that in women with no history of weight‐loss surgery and an early‐pregnancy body mass index (BMI) similar to the presurgery BMI of the postbariatric women. Methods This was a prospective, observational, longitudinal study conducted from April 2018 to June 2020 including 30 pregnant women who had undergone bariatric surgery and 30 who had not, matched for presurgery BMI. Participants were seen at three timepoints during pregnancy: 12–14, 20–24 and 30–32 weeks' gestation. At all visits, maternal blood pressure (BP) was measured and cardiac geometry and function were assessed using two‐dimensional (2D) transthoracic echocardiography. On a subset of patients (15 in each group), 2D speckle tracking was performed to assess global longitudinal and circumferential strain. Offline analysis was performed, and multilevel linear mixed‐effects models were used for all comparisons. Results Compared with the no‐surgery group, and across all trimesters, pregnant women with previous bariatric surgery had lower BP, heart rate and cardiac output and higher peripheral vascular resistance (P < 0.01 for all). Similarly, the postbariatric group demonstrated more favorable cardiac geometry and diastolic indices, including lower left ventricular mass, left atrial volume and relative wall thickness, together with higher E‐wave/A‐wave flow velocity across the mitral valve and higher mitral velocity (E′) at the lateral and medial annulus on tissue Doppler imaging (P < 0.01 for all). There was no difference in ejection fraction, although global longitudinal strain was lower in postbariatric women (P < 0.01), indicating better systolic function. Conclusion Our findings indicate better maternal cardiovascular adaptation in women with previous bariatric surgery compared with presurgery BMI‐matched pregnant women with no history of weight‐loss surgery. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Maternal Cardiac Function in Pregnancies with Metabolic Disorders

“…[ 110 ] When post-bariatric pregnant women were compared, longitudinally, to pregnant women without surgery but with early pregnancy BMI similar to the pre-surgery BMI of the post-bariatric women (n=30 in each group), we found that the former group had more favourable haemodynamic indices, diastolic and systolic function and altered cardiac geometry with lower LV mass and RWT. [ 111 ] It is conceivable that the cardiac changes observed in pregnant women with previous bariatric surgery may contribute to the lower prevalence of hypertensive disorders seen in this population.…”