Bariatric Surgery Minimizes Pregnancy Complications For Obese Women

May 21st, 2009

Women who undergo bariatric surgery and later become pregnant after losing weight may be at lower risk for pregnancy-related diabetes and high blood pressure—complications that can seriously affect the mother or the baby—than pregnant women with obesity.

Several independent reports have recently published these findings, including an evidence review from 75 studies that was led by Melinda A. Maggard, M.D., of the University of California at Los Angeles and the RAND Corporation in Santa Monica, CA, and performed by the Agency for Healthcare Research and Quality (AHRQ) Southern California Evidence-Based Practice Center at RAND.

Three of the 75 studies compared pregnancies of non-obese women with those of obese women as well as with pregnancies of women after surgical weight loss. A laparoscopic gastric banding study found that none of the women who underwent this surgery developed gestational diabetes or high blood pressure during their pregnancies, compared to 22 percent of obese pregnant women who developed diabetes and 3 percent who developed high blood pressure. Thirteen other studies supported these findings. Preterm delivery, low birth weight, and high birth weight rates were also likely to be better for women who had bariatric surgery than for obese women who did not.

The evidence report also found that:

• Nutritional problems during pregnancy after gastric bypass and laparoscopic gastric banding procedures like the LAP-BAND® System are uncommon, as long as there is adequate nutrition and vitamin supplementation.
• The typical recommended waiting period after bariatric surgery to become pregnant is 1 year, to allow rapid weight loss to occur first.
• Although the report states that the effects of bariatric surgery on fertility have not been well studied, some studies found possible improvement in the ability to conceive and deliver a child following bariatric surgery, normalization of sex hormones and menstrual irregularities, and improvement in polycystic ovary syndrome.
• The more frequently reported post-surgical complication in pregnant women, which also occurs in bariatric patients who do not become pregnant, is bowel obstruction (a life-threatening complication).
• There was not enough evidence to determine if having bariatric surgery affects the likelihood of needing a cesarean section to give birth.

Another, similar report was recently published in the International Journal of Gynecology and Obstetrics by Ben-Gurion University of the Negev’s (BGU) Professor Eyal Sheiner and Dr. Adi Weintraub, also of the Department of Obstetrics and Gynecology at Soroka University Medical Center in Israel.

In the study, 176 women had 301 (0.17%) deliveries that occurred before bariatric surgery and 354 women had 507 (0.28%) deliveries that occurred after bariatric surgery between 1988 and 2006. The study indicated that the risk of gestational diabetes alone drops by 60 percent when an obese woman has bariatric surgery before getting pregnant. There were significantly lower rates of hypertensive disorders in general and severe pre-eclampsia in particular, as well as lower rates of diabetes mellitus and anemia following bariatric surgery. The study did show, however, a significantly higher rate of cesarean births in women who had undergone bariatric surgery.

More than 50,000 women a year ages 18 to 45 undergo bariatric surgery procedures including gastric bypass and laparoscopic adjustable gastric banding. “Women of childbearing age who are considering weight-loss surgery should talk to their doctors about the implications for the future,” said AHRQ Director Carolyn M. Clancy, M.D. “While we don’t have all the answers yet, these preliminary findings may help physicians guide their patients.”

Sources: Some pregnancy-related complications are minimized for women who have had weight-loss surgery. Agency for Healthcare Research and Quality (AHRQ). Research Activities, January 2009, No. 341. Available at http://www.ahrq.gov/research/jan09/0109RA10.htm. Accessed May 21, 2009.

Some Pregnancy-Related Complications Minimized For Women Who Have Had Weight-Loss Surgery. Medical News Today. Nov 19, 2008. Available at http://www.medicalnewstoday.com/articles/129978.php. Accessed May 21, 2009.

Bariatric Surgery Minimizes Pregnancy Complications for Obese Women. American Associates, Ben-Gurion University of the Negev (AABGU). March 23, 2009. Available at http://www.aabgu.org/media-center/news-releases/bariatric-surgery-minimizes.html. Accessed May 21, 2009.

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