Obstetric Outcome Following Laparoscopic Adjustable Gastric Banding

Abstract

languages. Three months postpartum, women were mailed the Impact of Event Scale (IES) questionnaire, which measures posttraumatic stress symptoms. Demographics and obstetric characteristics were collected from medical records. Statistical analysis was by w 2 test and stress symptoms were analyzed by forward, stepwise logistic regression.The scores showed that 41 (33%) of the women had a low SOC; 68 (56%) had a moderate SOC; and 13 (11%) had a high SOC. There was no significant association between low SOC and age or parity, but it was more frequent in women who were born abroad (P = 0.045), had undergone a previous EMCS or vacuum extraction (P = 0.045), were single (P = 0.025), had a low socioeconomic background (P = 0.002), or had received antenatal counseling due to fear of childbirth (Pr0.001). Posttraumatic stress symptoms (IES) were seen to be normal in 80 (66%) women, moderate (needing follow-up) in 31 (25%), and severe in 11 (9%). Two independent risk factors for more than normal symptoms of posttraumatic stress were a low SOC and imminent fetal asphyxia as the main indication for the EMCS. One factor appeared to be protective for these symptoms: full cervical dilation at the time of the CS (P = 0.022).In this study, symptoms of posttraumatic stress disorder following EMCS were associated both with the personal coping style of the mother and the circumstances of the event. The authors suggested that an antenatal SOC evaluation could help determine who will need more follow-up or support. Especially vulnerable are women with a low SOC (eg, with an intense fear of childbirth during pregnancy, immigrants, and socially underprivileged women) and those in whom imminent asphyxia is an indication for the operation.L aparoscopic adjustable gastric banding (LAGB) has been used with greater frequency to control obesity among women of childbearing age. Little data on obstetric and neonatal outcomes in women after LAGB exist. This retrospective case-control study evaluated obstetric and neonatal outcomes in women who became pregnant after LAGB (13 cases) compared with obese women who did not undergo LAGB (14 controls). Data were gathered from a single institution in France. Women for the control group all had body mass indexes (BMIs) >30 kg/m 2 . Antepartum variables included age, race, parity, weight and BMI before LABG, weight loss before pregnancy, BMI at beginning of pregnancy, and history of cesarean delivery. Intrapartum variables were maternal weight gain during pregnancy, preterm delivery, presence of preeclampsia, gestational hypertension, or gestational diabetes mellitus, and labor and its complications. Neonatal outcomes were low birth weight (<2500 g), small for gestational age, macrosomia, Apgar score at 5 minutes, and umbilical artery blood gas analysis.All women had singleton pregnancies. The mean weight and BMI in the LAGB group were 95.2 ± 11.6 kg and 34.8 ± 3.2 kg/m 2 ; mean weight and BMI in the controls were 92.4 ± 12.8 kg and 35 kg/m 2 . The mean maternal weight gain was 5.5 kg in LAGB women compar...

Pregnancy after bariatric surgery – a review of benefits and risks

“…There was considerable heterogeneity in the studies regarding design, type of surgery, number of cases and control groups. Seven studies (10–16) took BMI into consideration and matched/adjusted for BMI or divided the control group according to BMI. Seven studies (17–23) compared deliveries before and after bariatric surgery, some in the same women and others in different women.…”

“…Finally, three studies compared index patients with population‐based or national pregnancy cohorts (24–26). Three studies addressed women with RYGB (11,13,14), four studies women with gastric banding (12,15,16,23), one study addressed women with biliopancreatic diversion (22) and nine included a mixture of women with RYGB and gastric banding (10,17–21,24–26). The number of operated women ranged from 13 to 507 and six studies included fewer than 50 women who had prior bariatric surgery (11,13–15,18,23).…”

“…Eight (10–12,14,17,21,22,25) described lower birthweight among cases compared with controls, and six studies (10,14,15,21,24,25) showed a lower incidence of macrosomia after bariatric surgery compared with pre‐surgery deliveries (17,21,22), BMI, age and parity‐matched controls (11), non‐operated obese women (10,12,14,15) or women in the general population (24,25). Six studies showed no difference in birthweight (13,15,16,18,23,24). A single study described a higher birthweight and an increased risk of macrosomia after bariatric surgery compared with the general population (26).…”

Pregnancy outcome following bariatric surgery

“…This was suggestive of possible nutritional growth restriction in these pregnancies. Ducarme et al found rates of low birthweight among individuals who had LAGB versus obese comparison group who did not undergo LAGB (7.7% versus 10.65%, P < 0.05).…”

“…Most studies report a reduced incidence of GDM in patients following bariatric surgery . Ducarme et al showed that the incidence of GDM (0% versus 22.1%, P < 0.05) and pre‐eclampsia (0% versus 3.1%, P < 0.05) were lower in the LAGB group than in the obese comparison group. GDM screening in malabsorptive patients, however, requires special considerations.…”