Photo Credit: Vladislav Stepanov

The following is a summary of “Pregnancy and offspring outcomes after pre-pregnancy bariatric surgery,” published in the September 2024 issue of Obstetrics and Gynecology by Eccles-Smith et al.

Bariatric surgery is increasingly utilized as a treatment for obesity, offering the potential for substantial and sustained weight loss. With a rising number of women becoming pregnant post-bariatric surgery, it is crucial to understand the associated maternal and fetal outcomes, as existing large-scale, matched studies on this subject are limited. This study aimed to evaluate the type of pre-pregnancy bariatric surgery performed, compare maternal, pregnancy, and neonatal outcomes with matched controls, and examine the effect of pre-pregnancy bariatric surgery on fetal growth, specifically focusing on the prevalence of small for gestational age (SGA) and large for gestational age (LGA) infants. A statewide hospital and perinatal data register was used for a cross-sectional matched study, including data from 2,018 births in 1,677 women who underwent pre-pregnancy bariatric surgery between 2013 and 2018. Out of these, 1,282 births from the first singleton pregnancy following bariatric surgery were analyzed, with each case matched 1:10 to women without bariatric surgery based on age, parity, smoking status, and body mass index (BMI). 

Pregnancy and neonatal outcomes were assessed using International Statistical Classification of Diseases Tenth Revision (ICD-10 AM) codes and neonatal birth records. Multivariable logistic regression was employed to determine the association between SGA and LGA and pre-pregnancy bariatric surgery. Results revealed that 93% of the women underwent laparoscopic sleeve gastrectomy. Offspring of mothers with pre-pregnancy bariatric surgery had significantly lower birth weights (3,223g ± 605g vs. 3418g ± 595g; p<0.001), a lower incidence of LGA (8.6% vs. 14.1%; p<0.001), and a higher incidence of SGA (10.7% vs. 7.3%; p<0.001) compared to offspring of matched controls. Additionally, these infants were more likely to be born preterm (10.5% vs. 7.8%; p=0.007). 

Women with prior bariatric surgery showed lower rates of gestational diabetes mellitus (15% vs. 20%; p<0.001) and pregnancy-induced hypertension (3.7% vs. 5.4%; p=0.01). Adjusted analyses indicated that pre-pregnancy bariatric surgery was associated with a reduced risk of LGA (OR 0.54, 95% CI 0.44-0.66) but an increased risk of SGA (OR 1.78, 95% CI 1.46-2.17). These findings suggest that while pre-pregnancy bariatric surgery may decrease certain obesity-related pregnancy complications, it is also associated with a higher incidence of preterm births and SGA infants.

Source: sciencedirect.com/science/article/abs/pii/S0002937824008998