Maternal and fetal delivery outcomes in pregnancies following bariatric surgery: a meta-analysis of the literature

Abstract

Aim: The objective of this study is to evaluate maternal and fetal outcomes following pregnancies after bariatric surgery as compared to the general population affected by obesity.

Methods: A systematic review was conducted through MEDLINE, Cochrane, and EMBASE to identify relevant studies from 2007 to 2016 with comparative data on the maternal and fetal delivery outcomes following bariatric surgery as compared to the population affected by obesity. The primary outcome analyzed was the rate of cesarean deliveries. Other outcomes included intrauterine growth restriction, small for gestational age, large for gestational age, macrosomia pregnancy-induced hypertension, gestational diabetes, assisted vaginal delivery, and preterm delivery. Statistical analysis was done using fixed-effects meta-analysis to compare the mean value of the two groups (Comprehensive Meta-Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).

Results: Out of 549 studies, 13 were quantitatively assessed and included for meta-analysis. The need for caesarean sections in post-bariatric women was found to be significantly lower when compared to women affected by obesity [odds ratio (OR) 0.623, P < 0.001). There were also significant reduction in the incidence of LGA (OR 0.491, P < 0.001), macrosomia (OR 0.251, P < 0.001), and assisted vaginal delivery (OR 0.807, P < 0.001) in the post bariatric group of women. There was an increase in the incidence of PIH (OR 1.113, P < 0.001), SGA (OR 2.305, P < 0.001) and IUGR (OR 2.099, P < 0.001). The incidence of preterm delivery (OR 0.982, P > 0.05) and gestational diabetes (OR 1.046, P > 0.05) were similar in both groups.

Conclusion: Patients affected by obesity considering conceiving in the near future should consider bariatric surgery prior to conception to lower their risk of potentially adverse delivery outcomes.

Keywords

Bariatric / pregnancy / neonatal / maternal

References

[1] Ogden CL,Kit BK.Prevalence of childhood and adult obesity in the United States, 2011-2012.JAMA2014;311:806-14 PMCID:PMC4770258

[2] Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville (MD): National Center for Health Statistics (US); 2016. Report No. 2016-1232

[3] Thepracticalguide:identification,evaluation,andtreatmentofoverweightandobesityinadults.Bethesda(MD):NationalInstitutesofHealth;NationalHeart,Lung,andBloodInstitute;NHLBIObesityEducationInitiative;NorthAmericanAssociationfortheStudyofObesity;2000.NIHPublicationNumber00-4084

[4] Picot J,Colquitt JL,Loveman E,Clegg AJ.The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation..Health Technol Assess2009;13:1-190, 215-357, iii-iv

[5] Butterworth J,Borg CM.Bariatric surgery, polycystic ovary syndrome, and infertility.J Obes2016;2016:1871594 PMCID:PMC5124647

[6] Luke B.Adverse effects of female obesity and interaction with race on reproductive potential.Fertil Steril2017;107:868-77

[7] Young T.Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain.Am J Obs Gynecol2002;187:312-8

[8] Smith G,Pell J,Dobbie R.Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study.Am J Public Health2007;97:157-62 PMCID:PMC1716235

[9] ACOG Practice Bulletin No.105..Bariatric surgery and pregnancy. Obstet Gynecol2009;113:1405-13

[10] Vrebosch L,Vansant G,Devlieger R.Maternal and neonatal outcome after laparoscopic adjustable gastric banding: a systematic review.Obes Surg2012;22:1568-79

[11] Galazis N,Simillis C.Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis.Eur J Obstet Gynecol Reprod Biol2014;181:45-53

[12] Yi X,Zhang J.A meta-analysis of maternal and fetal outcomes of pregnancy after bariatric surgery.Int J Gynecol Obstet2015;130:3-9

[13] Lapolla A,Dalfrà MG,De Luca M,Favretti F,Busetto L.Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding.Obes Surg2010;20:1251-7

[14] Abenhaim HA,Czuzoj-Shulman N,Klam SL.Pregnancy outcomes in women with bariatric surgery as compared with morbidly obese women.J Matern Neonatal Med2016;7058:1-22

[15] Adams TD,Davidson LE,Fraser A,Hashibe M,Kim J,Watson AJ,McKinlay R,Smith SC.Maternal and neonatal outcomes for pregnancies before and after gastric bypass surgery.Int J Obes (Lond)2015;39:686-94 PMCID:PMC5209789

[16] Amsalem D,Levi I,Sheiner E.Obstetric outcomes after restrictive bariatric surgery: what happens after 2 consecutive pregnancies?.Surg Obes Relat Dis2014;10:445-9

[17] Aricha-Tamir B,Levi I.Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery.Surg Obes Relat Dis2012;8:434-9

[18] Berlac JF,Lidegaard Ø.Obstetrical and neonatal outcomes in women following gastric bypass: a Danish national cohort study..Acta Obstet Gynecol Scand2014;93:447-53

[19] Ducarme G,Rodrigues A,Pharisien I.Obstetric outcome following laparoscopic adjustable gastric banding.Int J Gynecol Obstet2007;98:244-7

[20] Johansson K,Näslund I,Trolle Lagerros Y,Stephansson O.Outcomes of pregnancy after bariatric surgery.N Engl J Med2015;372:814-24

[21] Kjær MM,Breum BM.The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study..Am J Obstet Gynecol2013;208:464.e1-5

[22] Parker MH,Nijjar JB.Bariatric surgery and associated adverse pregnancy outcomes among obese women.J Matern Fetal Neonatal Med2016;29:1747-50

[23] Patel JA,Thomas RL,Colella JJ.Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass.Surg Obes Relat Dis2008;4:39-45

[24] Santulli P,Facchiano E,Ceccaldi PF,Msika S.Obstetrical and neonatal outcomes of pregnancies following gastric bypass surgery: a retrospective cohort study in a French referral centre.Obes Surg2010;20:1501-8

[25] Stephansson O,Näslund I.Bariatric surgery and preterm birth.N Engl J Med2016;375:805-6 PMCID:PMC5083664