Effect of bariatric surgery on pregnancy outcome

Weintraub, Adi Y.; Levy, Amalia; Levi, Isaac; Mazor, Moshe; Wiznitzer, Arnon; Sheiner, Eyal

doi:10.1016/j.ijgo.2008.07.008

Cited by 124 publications

(62 citation statements)

References 27 publications

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“…Though many gestation-related diseases that are exacerbated with obesity appear to be reduced after surgical weight loss (19, 27, 47, 48, 59), a serious cause for concern in pregnancies is the increase in delivery of small-for-gestational-age (SGA) babies. Intrauterine growth restriction (IUGR) is increased by 2-3 fold after bariatric surgery (15, 38).…”

Section: Discussionmentioning

confidence: 99%

“…The major advantage to bariatric surgery during the child-bearing years is the potential for improving reproductive capacity as well as achieving a healthier pregnancy. Improvements after bariatric surgery include return of normal menstrual cycles (16, 55), improved levels of reproductive hormones (44), recovery of luteal function (41), increased spontaneous (unassisted) pregnancies (36, 54), improvements in assisted pregnancies (36), lower risk of gestational diabetes and preeclampsia (19, 27), and reduced risk of large-for-gestational age (LGA) babies (27, 47, 48, 59). Thus, bariatric surgery holds great promise to improve reproductive outcomes for obese women interested in child-bearing.…”

Section: Introductionmentioning

confidence: 99%

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Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development

et al. 2018

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Bariatric surgery is increasingly employed to improve fertility and reduce obesity related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy. VSG dams studied on gestational day (G) 19 had reduced circulating T cell (CD3+ and CD8+) populations compared to lean or obese controls. Further, local interleukin 1 β and interleukin 1 receptor antagonist mRNA were increased in placenta of VSG dams. Placental barrier function was also affected, with increased trans-placental permeability to small molecules, increased matrix metalloproteinase 9 expression, and increased apoptosis in VSG. Furthermore, we identified increased placental mTOR signaling that may contribute to preserving the body weight of the fetuses during gestation. These changes occurred in the absence of a macronutrient deficit or gestational hypertension in the VSG dams. In summary, previous VSG in dams may contribute to fetal demise by affecting maternal immune system activity and compromise placental integrity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development

et al. 2018

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“…Patel et al found a significant decrease in mean birthweight and the incidence of macrosomia after Roux-en-Y gastric bypass compared with severely obese patients, and similar to those of nonobese and obese patients [20]. Similarly, Weintraub et al found a significant reduction in the incidence of macrosomia in women who delivered before bariatric surgery compared with those who delivered before (7.6% versus 3.2%; P = 0.004) [18]. Importantly, when comparing women with previous bariatric surgery ( n = 298) with all deliveries ( n = 159210) irrespective of maternal weight, women who had previous bariatric surgery were more likely to have macrosomic babies (OR 2.1, 95% CI: 1.4–3.0, P < 0.001) [21].…”

Section: Birth Weightmentioning

confidence: 92%

“…Similarly, in a large retrospective study of all women between 1988–2006 who delivered after bariatric surgery in a tertiary unit in Israel, Weintraub et al found a significant reduction in the rates of gestational diabetes mellitus (17.3% versus 11.0%; P = 0.009) and hypertensive disorders in pregnancy (23.6% versus 11.2%; P = 0.001) after analyzing 301 deliveries preceding bariatric surgery and 507 following surgery [18]. Wittgrove et al, in a retrospective study of 36 post Roux-en-Y gastric bypass pregnancies, found decreased rates of gestational diabetes mellitus, hypertensive disorders, as well as fetal macrosomia in the postsurgery group [19].…”

Section: Pregnancy Related Medical Complicationsmentioning

confidence: 99%

Pregnancy after Bariatric Surgery: A Review

Hezelgrave

Oteng‐Ntim

2011

Journal of Obesity

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Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to have positive effects on fertility and reduces the risk of gestational diabetes and preeclampsia. Moreover, there appears to be a reduced incidence of fetal macrosomia post-bariatric procedure, although there remains uncertainty about the increased rates of small-for-gestational age and intrauterine growth restricted infants, as well as premature rupture of membranes in this group. A number of case reports highlight that pregnancy following bariatric surgery is not without complications and it must be managed as high risk by the multidisciplinary team.

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“…Studies comparing pregnancy outcomes in those who became pregnant within one year of surgery (early group) compared to after one year (late group) did not find significant differences in maternal and fetal outcomes 18,39 despite one of these studies reporting that in the late group, the mean BMI at pregnancy was significantly lower than in the early group. There is a concern about safety and outcomes of pregnancies after such surgery.…”

Section: Pregnancy Following Bariatric Surgerymentioning

confidence: 98%

Bariatric Surgery in Pregnancy: Benefits, Risks and Obstetric Management

Gidiri

Greer

2011

Fet. Matern. Med. Rev.

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Obesity is a growing problem in obstetric practice. A recent study from Glasgow (UK) showed that 50% of women of childbearing age are either overweight (Body Mass Index [BMI] = 24.9–29.9kg/m2) or obese with 18% starting pregnancy as obese. Obesity prevalence has doubled over a decade from the early 1990’s. In the US it is estimated that 30% of reproductive-age women have a BMI greater than 30 kg/m while 7% have a BMI > 40 kg/m2. A recent report from the UK found that 5% of women had a BMI >35 kg/m2, 2% > 40 kg/m2 and 0.2% >50 kg/m2 with an association not only with social deprivation, but also with a higher prevalence of pre-existing medical disorders such as diabetes and hypertension and medical complications of pregnancy such as preeclampsia. Obesity was also associated with increased rates of macrosomia, operative delivery and postpartum haemorrhage. These data highlight the fact that obesity is an increasing health concern particularly in young women of childbearing age. Obesity will expose them to significant pregnancy complications ranging from miscarriage and fetal abnormality through to operative delivery and thromboembolism. There are also challenges for the delivery of maternity care to meet the needs of these women. As obesity is associated with significant pregnancy complications it is important that women enter pregnancy with an optimum body weight. Many complications, such as fetal abnormality occur in the first trimester and so pre-pregnancy weight reduction is preferred. Further, there is insufficient evidence to recommend specific dietary and/or physical activity interventions to reduce weight or moderate weight gain during pregnancy.

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Effect of bariatric surgery on pregnancy outcome

Abstract: A decrease in maternal complications, such as diabetes mellitus and hypertensive disorders, as well as a decrease in the rate of fetal macrosomia is achieved following bariatric surgery.

Cited by 124 publications

References 27 publications

Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development

Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development

Pregnancy after Bariatric Surgery: A Review

Bariatric Surgery in Pregnancy: Benefits, Risks and Obstetric Management

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