In comparison with pregnant women who are obese, the rates of negative outcomes for mothers or pregnant women and newborn babies may be lower after the woman has undergone bariatric surgery, according to an article released on November 19, 2008 in JAMA.
Bariatric surgery, sometimes known as weight loss surgery, can help obese people achieve a healthier body weight. The authors of the study note the importance of obesity in pregnancy: “Obesity has reached epidemic levels in the United States and is a leading cause of health-related disorders. Rates of surgical weight loss procedures have grown steeply and women account for many of these patients. Large numbers of women in their childbearing years may undergo bariatric surgery, which may change fertility following weight loss, alter nutritional requirements during pregnancy, or impact contraception to prevent pregnancy.”
To investigate the effects of obesity on pregnancy outcomes, Melinda A. Maggard, M.D., M.S.H.S., of the Rand Corporation, Santa Monica, CA, and colleagues systematically reviewed articles related to bariatric surgery in women of reproductive age in order to assess any associations between this surgery and various outcomes of pregnancy.
A total 75 articles were identified for inclusion in the review. The pooled data indicated that bariatric surgery incidence increased by eight-fold between 1998 and 2005 — from 12,480 to 113,500 cases. In the age group between 18 and 45 between 2003 and 205, women accounted for 83% of these procedures. That is, more than 50,000 women in this age group annually had bariatric surgeries, accounting for 49% of all bariatric surgery cases.
In further review, many studies showed a decrease in maternal complications after the surgery in comparison to obese women without the surgery. These rates approached those of non-obese control women. This included gestational diabetes and preeclampsia, which had lower rates in the surgery group than in the obese women. Additionally, weight gain due to pregnancy was less pronounced in the group which had undergone surgery.
Examining outcomes of newborns, the children of women who had undergone bariatric surgery had similar or better outcomes than obese women without it. These included premature delivery, low birth-weight, and macrosomia or large body. In comparison with non-obese controls, no differences were seen in outcomes.
The authors conclude that further work is necessary before major policy changes are instituted. “Research is needed to better delineate the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes. Optimizing success for contraception and producing healthy neonates following surgery will require a multidisciplinary effort by surgeons, primary care physicians, reproductive fertility specialists, obstetricians, and patients.”
Pregnancy and Fertility Following Bariatric Surgery: A Systematic Review
Melinda A. Maggard, MD, MSHS; Irina Yermilov, MD, MPH; Zhaoping Li, MD, PhD; Margaret Maglione, MPP; Sydne Newberry, PhD; Marika Suttorp, MS; Lara Hilton, BA; Heena P. Santry, MD; John M. Morton, MD, MPH; Edward H. Livingston, MD; Paul G. Shekelle, MD, PhD
JAMA. 2008;300(19):2286-2296.
Written by Anna Sophia McKenney