Advertisement

Maternal and neonatal outcome of women before vs. after bariatric surgery: A single tertiary center experience

  • D. Hazan
    Correspondence
    Corresponding author. Department of Surgery, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel.
    Affiliations
    Departments of Surgery, The Edith Wolfson Medical Center, Holon, Israel

    Departments of Surgery, Israel Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • M. Shimonov
    Affiliations
    Departments of Surgery, The Edith Wolfson Medical Center, Holon, Israel

    Departments of Surgery, Israel Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • A.L. Goldstein
    Affiliations
    Departments of Surgery, The Edith Wolfson Medical Center, Holon, Israel

    Departments of Surgery, Israel Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • K. Dayan
    Affiliations
    Departments of Surgery, The Edith Wolfson Medical Center, Holon, Israel

    Departments of Surgery, Israel Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author

      Highlights

      • Evaluation of maternal and neonatal outcomes of women with morbid obesity who delivered before BS as compared to their counterparts who delivered after BS.
      • Diabetes mellitus, found in 67% of the women who delivered before BS. Multivariate analysis of the data comparing the before and after bariatric groups. Specifically, different in age between the 2 groups which imply correlation and not causation.
      • Women who delivered before BS compared to women who delivered after BS had higher rates of anemia, gestational diabetes, and preeclampsia.
      • Women with deliveries before BS were characterized by higher birth weight in the neonates, more cases of premature membrane rupture, and relatively high number of SGAs.

      Abstract

      Background

      Obesity is associated with short term perinatal risks, causing increased risks in pre- and post-term birth, small and large for gestational (SGA/LGA), congenital anomalies, and perinatal mortality.

      Objective

      This study evaluate maternal and neonatal outcomes of women with morbid obesity who delivered before BS as compared to their counterparts who delivered after BS.

      Design

      A retrospective analysis in a single institute.

      Settings

      We use the data according to the ICD-9 code and were extracted from hospital archive.

      Patients

      Patients were divided int0 two groups consisted of those of who conceived after BS and those who conceived before BS.

      Interventions

      All women who underwent any BS and retrieved their obstetric files before or after the surgery.

      Main outcomes measures

      The pregnancy, delivery data and obstetric factors were collected, clinical variables, background data and surgical bariatric procedures, operating time, length of hospital stay.

      Results

      149 morbidly obese women, of which 45 delivered after BS (group I) and 104 delivered prior to BS (group II). The most frequent comorbidity was diabetes mellitus, found in 67% of the women who delivered before BS. Time to delivery was longer in the women before BS, (P = 0.015) for the after BS group. Women who delivered before BS compared to women who delivered after BS had higher rates of anemia (p = 0.038), gestational diabetes (p = 0.064), and preeclampsia (p = 0.043). Women with deliveries before BS were characterized by higher birth weight in the neonates, (p < 0.001), more cases of premature membrane rupture, (14%, p < 0.018) and relatively high number of SGAs. A multivariate analysis of the data imply correlation to age and not causation.

      Limitations

      This study was a small retrospective study and selection bias can occur which may reduce the accuracy of the results.

      Conclusions

      There are clear health benefits of weight loss for morbidly obese women of reproductive age, and BS has an important role to play in this population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Health Organization. Obesity and Overweight: Fact Sheet [Internet] [cited 2019 Jan 9].

        • Catalano P.M.
        • Shankar K.
        Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child.
        BMJ. 2017; 356 (j1 10.1136/bmj.j)
        • Marchi J.
        • Berg M.
        • Dencker A.
        • Olander E.K.
        • Begley C.
        Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.
        Obes Rev. 2015; 16: 621-638https://doi.org/10.1111/obr.12288
        • Heslehurst N.
        • Vieira R.
        • Hayes L.
        • et al.
        Maternal body mass index and post-term birth: a systematic review and meta-analysis.
        Obes Rev. 2017; 18: 293-308https://doi.org/10.1111/obr.12489
        • Godfrey K.M.
        • Reynolds R.M.
        • Prescott S.L.
        • et al.
        Influence of maternal obesity on the long-term health of offspring.
        Lancet Diabetes Endocrinol. 2017; 5: 53-64https://doi.org/10.1016/S2213-8587(16)30107-3
        • Maggard M.A.
        • Yermilov I.
        • Li Z.
        • et al.
        Pregnancy and fertility following bariatric surgery: a systematic review.
        JAMA. 2008; 300: 2286-2296
        • Edison E.
        • Whyte M.
        • van Vlymen J.
        • et al.
        BSin obese women of reproductive age improves conditions that underlie fertility and pregnancy outcomes: retrospective cohort study of UK national BSRegistry (NBSR).
        Obes Surg. 2016; 26: 2837-2842https://doi.org/10.1007/s11695-016-2202-4
        • Arias E.
        • Martínez P.R.
        • Ka Ming Li V.
        • Szomstein S.
        • Rosenthal R.J.
        Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity.
        Obes Surg. 2009; 19 (Epub 2009 Mar 12): 544-548
        • Sheiner E.
        • Willis K.
        • Yogev Y.
        Bariatric surgery: impact on pregnancy outcomes.
        Curr Diabetes Rep. 2013; 13: 19-26
        • Kominiarek M.A.
        Preparing for and managing a pregnancy after bariatric surgery.
        Semin Perinatol. 2011; 35: 356-361
        • Sheiner E.
        • Levy A.
        • Menes T.S.
        • Silverberg D.
        • Katz M.
        • Mazor M.
        Maternal obesity as an independent risk factor for caesarean delivery.
        Pediatr Perinat Epidemiol. 2004; 18: 196-201
        • Burke A.E.
        • Bennett W.L.
        • Jamshidi R.M.
        • et al.
        Reduced incidence of gestational diabetes with bariatric surgery.
        J Am Coll Surg. 2010; 211: 169-175
        • Burstein E.
        • Levy A.
        • Mazor M.
        • Wiznitzer A.
        • Sheiner E.
        Pregnancy outcome among obese women: a prospective study.
        Am J Perinatol. 2008; 25: 561-566
        • Ducarme G.
        • Revaux A.
        • Rodrigues A.
        • Aissaoui F.
        • Pharisien I.
        • Uzan M.
        Obstetric outcome following laparoscopic adjustable gastric banding.
        Int J Gynecol Obstet. 2007; 98: 244-247
        • Lapolla A.
        • Marangon M.
        • Dalfr_a M.G.
        • et al.
        Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding.
        Obes Surg. 2010; 20: 1251-1257
        • Weintraub A.Y.
        • Levy A.
        • Levi I.
        • Mazor M.
        • Wiznitzer A.
        • Sheiner E.
        Effect of BSon pregnancy outcome.
        Int J Gynecol Obstet. 2008; 103: 246-251
        • Lesko J.
        • Peaceman A.
        Pregnancy outcomes in women after BScompared with obese and morbidly obese controls.
        Obstet Gynecol. 2012; 119: 547-554
        • Salsberry P.J.
        • Reagan P.B.
        Taking the long view: the prenatal environment and early adolescent overweight.
        Res Nurs Health. 2007; 30: 297-307
        • Rottenstreich A.
        • Levin G.
        • Kleinstern G.
        • Rottenstreich M.
        • Elchalal U.
        • Elazary R.
        The effect of surgery-to-conception interval on pregnancy outcomes after sleeve gastrectomy.
        Surg Obes Relat Dis. 2018 Dec; 14: 1795-1803
        • Coupaye M.
        • Legardeur H.
        • Sami O.
        • Calabrese D.
        • Mandelbrot L.
        • Ledoux S.
        Impact of Roux en Y gastric bypass and sleeve gastrectomy on fetal growth and relationship with maternal nutritional status.
        Surg Obes Relat Dis. 2018 Oct; 14: 1488-1494
        • Marceau P.
        • Kaufman D.
        • Biron S.
        • et al.
        Outcome of pregnancies after biliopancreatic diversion.
        Obes Surg. 2004; 14: 318-324