Reduced Incidence of Gestational Diabetes with Bariatric Surgery

Burke, Anne E.; Bennett, Wendy L.; Jamshidi, Roxanne; Gilson, M; Clark, Jeanne M.; Segal, Jodi B; Shore, Andrew D.; Magnuson, Thomas; Dominici, Francesca; Wu, Albert W.; Makary, Martin A.

doi:10.1016/j.jamcollsurg.2010.03.029

Cited by 74 publications

(50 citation statements)

References 38 publications

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“…If a pregnancy complication was over-coded as a "rule-out" diagnosis, our results could be biased towards detecting fewer differences in follow-up rates between the two pregnancy groups. However, we used previously tested definitions of pregnancy complications, 19,20 and the prevalence rates of GDM and hypertensive disorders were similar to national prevalence rates. [28][29][30] Other diagnoses such as obesity and preterm labor may have been under-coded in our data set, as our rate for preterm labor was lower than anticipated, 31 and there is evidence that obesity is frequently under recognized and under-coded.…”

Section: Discussionmentioning

confidence: 99%

“…Using previously developed definitions, 19,20 women were assigned to the "complicated pregnancy group" if they had one or more of the following medical complications: GDM, pregestational diabetes (DM), or hypertensive disorders in pregnancy (preeclampsia, eclampsia, gestational hypertension, chronic hypertension and preeclampsia superimposed on chronic hypertension) (Supplemental Table A, available online). 19 We elected to include pregestational Type 1 and 2 diabetes along with GDM in the "complicated pregnancy group" for several reasons: 1) we had decided to include chronic hypertension, also a pre-pregnancy diagnosis, because it was part of the definition for hypertensive disorders in pregnancy 11 ; 2) newer evidence supports "diabetes in pregnancy" as a continuum of glucose intolerance with many pregnant patients having undiagnosed type 2 diabetes 21 ; and 3) we designed our analyses to enable separate assessments between diagnoses of GDM and DM.…”

Section: Classification Of Women Into Complicated and Comparison Pregmentioning

confidence: 99%

“…Table 3 shows the results of the multivariate analyses to determine predictors of receiving primary care after delivery. Among women with Medicaid coverage, statistically significant sociodemographic predictors of primary care after delivery were White race (OR 1.37, p<0.001) or Hispanic ethnicity (OR 1.23, p=0.05), older age (age 25-34: OR 1.28, p<0.001; age > 35: OR 1.42, p<0.001 [reference = age [18][19][20][21][22][23][24]) and living in a neighborhood with a higher proportion of people without a high school diploma (Tertile 3: OR 1.28, p<0.001) ( Table 3). Among women with Medicaid preeclampsia (OR 1.24, p=0.03), DM (OR 1.70, p<0.001) (but not GDM), thyroid disease (OR 1.96, p<0.001), asthma (OR 1.35, p<0.001) and depression (OR 1.25, p=0.01) were predictors.…”

Section: Utilization Of Primary Care In the 12 Months Following Deliverymentioning

confidence: 99%

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Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

et al. 2014

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BACKGROUND: Because pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy, are risk factors for diabetes and cardiovascular disease, post-delivery follow-up is recommended. OBJECTIVE: To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications. RESEARCH DESIGN: Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland. SUBJECTS: 7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy. MEASURES: We compared primary and postpartum obstetric care utilization rates in the 12 months after delivery between the complicated and comparison pregnancy groups. We conducted multivariate logistic regression to assess the association between pregnancy complications, sociodemographic predictor variables and utilization of care, stratified by insurance type. RESULTS: Women with a complicated pregnancy were older at delivery (p<0.001), with higher rates of cesarean delivery (p<0.0001) and preterm labor or delivery (p<0.0001). Among women with Medicaid, 56.6 % in the complicated group and 51.7 % in the comparison group attended a primary care visit. Statistically significant predictors of receiving a primary care visit included non-Black race, older age, preeclampsia or DM, and depression. Among women with commercial health insurance, 60.0 % in the complicated group and 49.5 % in the comparison group attended a primary care visit. Pregnancy complication did not predict a primary care visit among women with commercial insurance. CONCLUSIONS: Women with pregnancy complications were more likely to attend primary care visits postdelivery compared to the comparison group, but overall visit rates were low. Although Medicaid expansion has potential to increase coverage, innovative models for preventive health services after delivery are needed to target women at higher risk for chronic disease development.

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Section: Discussionmentioning

confidence: 99%

Section: Classification Of Women Into Complicated and Comparison Pregmentioning

confidence: 99%

Section: Utilization Of Primary Care In the 12 Months Following Deliverymentioning

confidence: 99%

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Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

et al. 2014

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“…6 The weight loss promoted by bariatric surgery has been shown to improve pregnancy outcomes, including hypertensive disorders of pregnancy, preeclampsia, preterm birth, and gestational diabetes. [6][7][8][9] However, weight loss after surgery is related to decreased caloric consumption and a state of some malabsorption. The type of bariatric surgeries that lead to the highest risk of nutrient deficiencies are extended Roux-en-Y gastric bypass procedures, or bilio-pancreatic diversions.…”

Section: Discussionmentioning

confidence: 99%

“…5 It reduces obesity-related comorbidities and mortality, including pregnancy-related complications. [6][7][8][9] While preconception bariatric surgery results in weight loss and has generally been considered safe and beneficial for mothers and neonates, 10 malabsorptive procedures may also lead to nutritional deficiencies that could adversely affect pregnancy.…”

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confidence: 99%

Laboratory Testing for and Diagnosis of Nutritional Deficiencies in Pregnancy Before and After Bariatric Surgery

Gadgil

Chang

Richards

et al. 2014

Journal of Women's Health

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Objective: Bariatric surgery can reduce the risk of obesity-related complications of pregnancy, but may cause essential nutrient deficiencies. To assess adherence to laboratory testing guidelines, we examined frequency of testing for and diagnosis of deficiency during preconception and pregnancy using claims data in women with a delivery and bariatric surgery. Methods: Retrospective analysis of claims from seven Blue Cross Blue Shield plans between 2002 and 2008. We included women with a delivery and bariatric surgery within the study period. We used common procedural terminology (CPT) and ICD-9 codes to define laboratory testing and deficiencies for iron, folate, vitamin B12, vitamin D, and thiamine. Using Student's t-test and chi-square testing, we compared frequency of laboratory tests and diagnoses during 12 months preconception and 280 days of pregnancy between women with pregnancy before versus after surgery. We used multivariate logistic regression to evaluate for predictors of laboratory testing. Results: We identified 456 women with pregnancy after bariatric surgery and 338 before surgery. The frequency of testing for any deficiency was low (9%-51%), but higher in those with pregnancy after surgery ( p < 0.003). The most common deficiency was vitamin B12 (12%-13%) with pregnancy after surgery ( p < 0.006). Anemia and number of health provider visits were independent predictors of laboratory testing. Conclusion: Women with pregnancy after bariatric surgery were tested for and diagnosed with micronutrient deficiencies more frequently than those with pregnancy before surgery. However, most laboratory testing occurred in less than half the women and was triggered by anemia. Increased testing may help identify nutrient deficiencies and prevent consequences for maternal and child health.

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Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes After Metabolic and Bariatric Surgery

et al. 2023

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ImportanceMetabolic and bariatric surgery (MBS) is the most efficient therapeutic option for severe obesity. Most patients who undergo MBS are women of childbearing age. Data in the scientific literature are generally of a low quality due to a lack of well-controlled prospective trials regarding obstetric, neonatal, and child outcomes.ObjectiveTo assess the risk-benefit balance associated with MBS around obstetric, neonatal, and child outcomes.Design, Setting, and ParticipantsThe study included 53 813 women on the French nationwide database who underwent an MBS procedure and delivered a child between January 2012 and December 2018. Each women was their own control by comparing pregnancies before and after MBS.ExposuresThe women included were exposed to either gastric bypass or sleeve gastrectomy.Main Outcomes and MeasuresThe study team first compared prematurity and birth weights in neonates born before and after maternal MBS with each other. Then they compared the frequencies of all pregnancy and child diagnoses in the first 2 years of life before and after maternal MBS with each other.ResultsA total of 53 813 women (median [IQR] age at surgery, 30 [26-35] years) were included, among 3686 women who had 1 pregnancy both before and after MBS. The study team found a significant increase in the small-for-gestational-age neonate rate after MBS (+4.4%) and a significant decrease in the large-for-gestational-age neonate rate (−12.6%). The study team highlighted that compared with pre-MBS births, after MBS births had fewer occurrences of gestational hypertension (odds ratio [OR], 0.16; 95% CI, 0.10-0.23) and gestational diabetes for the mother (OR, 0.39; 95% CI, 0.34-0.45), as well as fewer birth injuries to the skeleton (OR, 0.27; 95% CI, 0.11-0.60), febrile convulsions (OR, 0.39; 95% CI, 0.21-0.67), viral intestinal infections (OR, 0.56; 95% CI, 0.43-0.71), or carbohydrate metabolism disorders in newborns (OR, 0.54; 95% CI 0.46-0.63), but an elevated respiratory failure rate (OR, 2.42; 95% CI, 1.76-3.36) associated with bronchiolitis.Conclusions and RelevanceThe risk-benefit balance associated with MBS is highly favorable for pregnancies and newborns but may cause an increased risk of respiratory failure associated with bronchiolitis. Further studies are needed to better assess the middle- and long-term benefits and risks associated with MBS.

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Reduced Incidence of Gestational Diabetes with Bariatric Surgery

Cited by 74 publications

References 38 publications

Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

Laboratory Testing for and Diagnosis of Nutritional Deficiencies in Pregnancy Before and After Bariatric Surgery

Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes After Metabolic and Bariatric Surgery

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