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.

Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort

“…In the comparison of pregnancies in women with a history of bariatric surgery with women having normal body mass index, a higher incidence of pregnancy complications has been observed. This is in contrast to when obese women were used as the control group, often no significant reduction in complications was reported [ 11 , 12 , 22 , 23 ]. Bariatric surgery may reduce the occurrence of obesity-related complications during pregnancy, but not to the same extent as in the population of women with normal weight [ 17 ].…”

“…A meta-analysis showed lower rates of preeclampsia and gestational diabetes, but increased maternal anemia [ 24 ]. However, there was variation among the studies used in the meta-analysis on pregnancy-induced hypertension [ 23 ]. While most studies did not show any difference between the two groups with and without a history of surgery, one study showed a lower prevalence of hypertension in pregnant women who underwent bariatric surgery compared to pregnant women with obesity [ 25 ].…”

Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort

“…Nausea or vomiting during pregnancy may exacerbate the mother's poor nutritional status, and serious complications may occur unless adequate supplementation is taken (20). Studies on birth weight after bariatric surgery show a decrease in average birth weight and fetal macrosomia, and an increase in small for gestational age (SGA) fetuses and intrauterine growth restriction (IUGR) of infants (11,12,23). These trends are most likely caused by maternal malnutrition following bariatric surgery and micronutrient de ciency, which may be exacerbated during pregnancy (22).…”

Bariatric surgery and its impact on fertility, pregnancy and its outcome: A narrative review

“…Studies showed reduction in incidence of preeclampsia after bariatric surgery were many [ 26 , 31 , 32 , 33 ]. An increase in incidence of pregnancy induced hypertension was reported in meta-analysis involving 13 studies by Young B et al (2018) [ 34 ]. The increase in incidence could be attributed by older age group and white patients.…”