Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes

Rasteiro, Cátia; Araújo, Célia; Cunha, Sara Bernardes da; Caldas, Rita; Mesquita, Joana; Seixas, Adérito; Augusto, N; Ramalho, Carla

doi:10.1007/s11695-018-3395-5

Cited by 26 publications

(14 citation statements)

References 31 publications

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“…In the present study, gestational weight gain was below the NAM recommendations in 75% of the women who conceived within 12 months and in 30% of the women who conceived after 12 months. Our results are in accordance with two other studies that also found that gestational weight gain was higher and more adequate when pregnancy occurred more than 12 months after surgery [19,26].…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies found no associations between the time from surgery to conception and adverse pregnancy or neonatal outcomes [4,[15][16][17][18][19][20][21][22][23][24]. In fact, most studies confirm that the risk of these outcomes is not increased during the first 12 months after bariatric surgery compared to later pregnancies [4,16,17,19,22,25].…”

Section: Discussionmentioning

confidence: 98%

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A Matter of Timing—Pregnancy After Bariatric Surgery

et al. 2021

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Purpose Current guidelines recommend to avoid pregnancy for 12–24 months after bariatric surgery because of active weight loss and an increased risk of nutritional deficiencies. However, high-quality evidence is lacking, and only a few studies included data on gestational weight gain. We therefore evaluated pregnancy and neonatal outcomes by both surgery-to-conception interval and gestational weight gain. Materials and Methods A multicenter retrospective analysis of 196 singleton pregnancies following Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was conducted. Pregnancies were divided into the early group (≤ 12 months), the middle group (12–24 months), and the late group (> 24 months) according to the surgery-to-conception interval. Gestational weight gain was classified as inadequate, adequate, or excessive according to the National Academy of Medicine recommendations. Results Pregnancy in the early group (23.5%) was associated with lower gestational age at delivery (267.1 ± 19.9 days vs 272.7 ± 9.2 and 273.1 ± 13.5 days, P = 0.029), lower gestational weight gain (− 0.9 ± 11.0 kg vs + 10.2 ± 5.6 and + 10.0 ± 6.4 kg, P < 0.001), and lower neonatal birth weight (2979 ± 470 g vs 3161 ± 481 and 3211 ± 465 g, P = 0.008) than pregnancy in the middle and late group. Inadequate gestational weight gain (40.6%) was associated with lower gestational age at delivery (266.5 ± 20.2 days vs 273.8 ± 8.4 days, P = 0.002) and lower neonatal birth weight (3061 ± 511 g vs 3217 ± 479 g, P = 0.053) compared to adequate weight gain. Preterm births were also more frequently observed in this group (15.9% vs 6.0%, P = 0.037). Conclusion Our findings support the recommendation to avoid pregnancy for 12 months after bariatric surgery. Specific attention is needed on achieving adequate gestational weight gain.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

A Matter of Timing—Pregnancy After Bariatric Surgery

et al. 2021

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“…Six observational studies reporting fetal outcomes following pregnancy after bariatric surgery were identified and a meta-analysis comparing early pregnancy versus delayed pregnancy was undertaken [133][134][135][136][137][138]. Delaying pregnancy was associated with a trend towards lower odds for admission in the neonatal intensive care unit (OR 0.73, 95% 0.45 to 1.18).…”

Section: Justificationmentioning

confidence: 99%

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

et al. 2020

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Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

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“…This is consistent with recommendations to delay pregnancy for 12–24 months or until the acute phase of weight loss is resolved . These recommendations are based on expert opinion, however, and a number of observational studies have reported no difference in outcomes for women who conceive sooner than the recommended time frame . We found lower rates of hypertension and admission to NICU/SCN among women who conceived <12 months after bariatric surgery compared with women who conceived ≥12 months after surgery.…”

Section: Discussionmentioning

confidence: 54%

Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study

Ibiebele

Gallimore

Schnitzler

et al. 2019

BJOG

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Objectives To describe the population of women having bariatric surgery and compare the pregnancy outcomes for women having bariatric surgery with a non-bariatric surgery population having a first and second pregnancy.Design Population-based record linkage study.Setting New South Wales (NSW), Australia.Population All women aged 15-45 years with a hospital record in NSW (2002NSW ( -2014 and all women giving birth in NSW (1994-2015; n = 1 606 737 women).Methods Pregnancy and birth outcomes were compared between first and second pregnancies using repeated-measures logistic regression and paired Student's t-tests. Bariatric and non-bariatric groups were also compared.Main outcome measures Maternal diabetes, preterm birth (<37 weeks of gestation) and large for gestational age.Results There was a 13-fold increase in hospitalisations for primary bariatric surgery during 2002-2014. Compared with the general birthing population, women who had bariatric surgery experienced higher rates of hypertension, diabetes, and preterm birth. Among women who had bariatric surgery between a first and second pregnancy, there were reduced rates of hypertension (OR 0.39, 95% CI 0.29-0.53), spontaneous preterm birth (OR 0.37, 95% CI 0.16-0.86), infants that were large for gestational age (OR 0.63, 95% CI 0.44-0.88), and the admission of infants to a special care nursery or neonatal intensive care (OR 0.64, 95% CI 0.46-0.90) in the second pregnancy. Rates for small-for-gestational age and gestational diabetes following surgery were 8.3 and 11.4%, respectively Conclusions Bariatric surgery between a first and second pregnancy was associated with reductions in obesity-related adverse pregnancy outcomes. Bariatric surgery performed for the management of obesity in accordance with current clinical criteria is associated with improved pregnancy outcomes in a subsequent pregnancy.Tweetable abstract Bariatric surgery for obesity may improve pregnancy and birth outcomes in a subsequent pregnancy.

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Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes

Abstract: Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.

Cited by 26 publications

References 31 publications

A Matter of Timing—Pregnancy After Bariatric Surgery

A Matter of Timing—Pregnancy After Bariatric Surgery

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study

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