Perinatal Outcomes Including Breastfeeding after Bariatric Surgery in Women with Grade 3 Obesity

Abstract

Background: Reports on perinatal outcomes following bariatric surgery (BS) are common, however, information on how postsurgery pregestational grade 3 obesity (BMI ≥ 40 kg/m 2 ) could influence these outcomes as well as breastfeeding (BF) rates is limited. Objective: The primary objective was to compare perinatal outcomes including BF of women with grade 3 obesity, 83 of whom had BS and 166 matched controls who did not (no-BS). The secondary objective was to determine if the severity of pregestational grade 3 obesity (low 40-44 and high BMI ≥ 45 kg/m 2 ) influenced these outcomes. Methods: Retrospective cohort study. Controls were matched by pregestational BMI, mothers' age, parity and race. Results: Women in the BS group had lower rates of gestational diabetes mellitus (GDM) (7 vs 19%), chronic hypertension (CHTN) (7 vs 23%) and preeclampsia (7 vs 17%). Among their infants, small for gestation was frequent (18 vs 2%) while macrosomia was rare (4 vs 15%). In the BS and no-BS groups, BF outcomes including exclusive (24%) and any BF (66%) were equal. In the no-BS high BMI subgroup, the rates of CHTN (32 vs 15%) and formula feeding at discharge (44 vs 25%) were higher and any BF rate (56 vs 75%) was lower than in the low BMI no-BS subgroup. Conclusion: Although poor fetal growth is a concern, BS decreased the rates of hypertensive disorders, GDM and macrosomia even in women with pregestational grade 3 obesity and higher BMI. Among women in the no-BS group the prevalence of CHTN and macrosomia rises while BF initiation decrease as the severity of obesity worsens.