Maternal and Perinatal Outcomes After Laparoscopic Sleeve Gastrectomy

Abstract

(Obstet Gynecol 2018;131:451–456) Bariatric surgery has been shown to improve fertility in women. In recent years, laparoscopic sleeve gastrectomy, a restrictive procedure, has become the most frequently utilized bariatric procedure. However, current recommendations regarding the care of pregnant women after bariatric surgery are based on studies with patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. Therefore, the authors of the present study performed a review of pregnancies among patients who underwent laparoscopic sleeve gastrectomy and related maternal and perinatal outcomes.

Pregnancy after bariatric surgery: risks and benefits

“…We recently have published a case-control study that included 119 patients after sleeve gastrectomy and 119 control subjects who were matched for preoperative body mass index, age, parity, delivery history, and delivery year. 2 We have shown a 3-fold increased risk for small-for-gestational-age infants in the postesleeve gastrectomy group. This finding challenges the presumption that the observed risk of impaired fetal growth is due to malabsorption 1 and suggests that the deleterious effect on fetal growth may involve factors other than malabsorption.…”

Laparoscopic Sleeve Gastrectomy: Outcomes, Safety and Complications

“…Cesarean delivery rates were lower in the LSG group (10.1% vs 20.2%, P = 0.04) [47]. However, LSG patients also had higher risk of iron deficiency anemia requiring treatment with intravenous iron supplementation during pregnancy [47]. This suggests that although LSG improves pregnancy outcomes, however, pregnant women need close monitoring for nutritional deficiencies post LSG.…”

“…Conversely, LSG was associated with higher proportions of small-for-gestational-age (SGA) neonates (14.3% vs 4.2%, P = 0.01) and low-birth-weight neonates (12.6% vs 4.2%, P = 0.03) [47]. Cesarean delivery rates were lower in the LSG group (10.1% vs 20.2%, P = 0.04) [47]. However, LSG patients also had higher risk of iron deficiency anemia requiring treatment with intravenous iron supplementation during pregnancy [47].…”

“…Obese women have increased rates of adverse obstetric outcomes that include gestational diabetes mellitus, gestational hypertension, preeclampsia, cesarean section delivery, and adverse neonatal outcomes including congenital malformations, macrosomia, and stillbirths [46]. WL with LSG has better maternal and perinatal outcomes [47]. A retrospective study comparing women who had undergone LSG with matching controls found that the LSG group had lower rates of gestational DM (3.4% vs 17.6%, P = 0.001), large-for-gestational-age neonates (1.7% vs 19.3%, P = 0.001), and birth weight > 4000 grams (0.8% vs 7.6%, P = 0.02) [47].…”

“…A retrospective study comparing women who had undergone LSG with matching controls found that the LSG group had lower rates of gestational DM (3.4% vs 17.6%, P = 0.001), large-for-gestational-age neonates (1.7% vs 19.3%, P = 0.001), and birth weight > 4000 grams (0.8% vs 7.6%, P = 0.02) [47]. Conversely, LSG was associated with higher proportions of small-for-gestational-age (SGA) neonates (14.3% vs 4.2%, P = 0.01) and low-birth-weight neonates (12.6% vs 4.2%, P = 0.03) [47]. Cesarean delivery rates were lower in the LSG group (10.1% vs 20.2%, P = 0.04) [47].…”