Maternal and perinatal outcomes in women conceiving after bariatric surgery: A cohort study

Abstract

Obesity in women, a global issue, is being widely managed with bariatric surgery worldwide. According to recommended guidelines, pregnancy should be avoided for 12 to 24 months following surgery due to various risks. We assessed if surgery-to-conception time has a relation with pregnancy outcomes taking into account gestational weight gain. A cohort study between 2015 and 2019 followed-up pregnancies after various types of bariatric surgeries performed (e.g. Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, gastric bypass with Roux-en-Y gastroenterostomy) in Tawam Hospital, Al Ain, United Arab Emirates. There were 5 surgery-to-conception groups: <6 months, 6 to 12 months, 13 to 18 months, 19 to 24 months, and >24 months. There were 3 gestational weight gain groups: inadequate, adequate, or excessive (based on the National Academy of Medicine classification). Maternal and neonatal outcomes were compared using analysis of variance and chi-square tests. There were 158 pregnancies. Booking maternal body mass index and weight were higher among mothers who conceived <6 months following surgery (P < .001). Gestational weight gain was not related to the type of bariatric surgery (P = .24), but it was far more often inadequate in mothers who conceived <12 months following surgery (P = .002). Maternal (including pregnancy-induced hypertension and gestational diabetes mellitus) and neonatal outcomes were not statistically significantly associated with surgery-to-conception duration. However, birth weight was lower when gestational weight gain was inadequate (P = .03). There is a negative relationship between shorter bariatric surgery-to-conception interval and gestational weight gain, a feature related to neonatal birth weight. Conception should be delayed to improve pregnancy outcomes following bariatric surgery.

Nutritional Implications of Bariatric Surgery on Pregnancy Management—A Narrative Review of the Literature

“…The American Society for Metabolic and Bariatric Surgery, the Obesity Society, and the American Association of Clinical Endocrinology suggest a TTC interval of 12 to 18 months [25] During the rapid weight loss period, there is a high risk of nutritional deficiencies and, subsequently, the impairment of fetal growth or spontaneous abortion. Different studies confirm that pregnancies started under 12 months after BS are associated with a higher risk of inadequate gestational weight gain (GWG), which, in consequence, can negatively influence fetal growth [26][27][28]. A study by Solaiman et al in a group of 158 pregnant patients after BS indicated that there was a negative relationship between shorter TTC interval and GWG (p = 0.002) and lower birth weight and inadequate GWG (p = 0.03); however, the study showed no significant correlation between TTC and PIH, and GDM and neonatal outcomes [26].…”

“…Different studies confirm that pregnancies started under 12 months after BS are associated with a higher risk of inadequate gestational weight gain (GWG), which, in consequence, can negatively influence fetal growth [26][27][28]. A study by Solaiman et al in a group of 158 pregnant patients after BS indicated that there was a negative relationship between shorter TTC interval and GWG (p = 0.002) and lower birth weight and inadequate GWG (p = 0.03); however, the study showed no significant correlation between TTC and PIH, and GDM and neonatal outcomes [26]. In a recent Chinese study, Wang et al found that the spontaneous abortion rate was higher when TTC was lower than 2 years, compared to a TTC interval of 2 years and more (p = 0.04) [29].…”

Medical and Psychological Aspects of Pregnancy in Women with Obesity and after Bariatric Surgery

“…Significant weight loss may result in nutrient deficiencies (including vitamin B12 and folic acid) and anemia [70], lower gestational weight gain, lower gestational age at delivery, lower birth weight, and preterm birth [71]. There was no relationship between gestational weight gain and the type of bariatric surgery [72].…”

“…However, some scientific reports do not support a correlation between the time from surgery to conception and early or late fetal growth in pregnancies conceived after gastric bypass surgery [73], as well as maternal outcomes (including pregnancy-induced hypertension and gestational diabetes) and neonatal outcomes independently on the type of operation [72]. Even studies report that pregnancies 18 months after gastric bypass, compared with pregnancies in the earlier period, are associated with a higher risk of cesarean section or intravenous iron supplementation [74].…”

“…Even studies report that pregnancies 18 months after gastric bypass, compared with pregnancies in the earlier period, are associated with a higher risk of cesarean section or intravenous iron supplementation [74]. There are also conflicting reports regarding the relationship between weight gain in pregnancies conceived at different times after bariatric surgery and low birth weight [72,74]. The latest recommendations do not specify the time after MBS to conception but indicate the moment of achieving stable body weight [46].…”