Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes After Metabolic and Bariatric Surgery

Abstract

ImportanceMetabolic and bariatric surgery (MBS) is the most efficient therapeutic option for severe obesity. Most patients who undergo MBS are women of childbearing age. Data in the scientific literature are generally of a low quality due to a lack of well-controlled prospective trials regarding obstetric, neonatal, and child outcomes.ObjectiveTo assess the risk-benefit balance associated with MBS around obstetric, neonatal, and child outcomes.Design, Setting, and ParticipantsThe study included 53 813 women on the French nationwide database who underwent an MBS procedure and delivered a child between January 2012 and December 2018. Each women was their own control by comparing pregnancies before and after MBS.ExposuresThe women included were exposed to either gastric bypass or sleeve gastrectomy.Main Outcomes and MeasuresThe study team first compared prematurity and birth weights in neonates born before and after maternal MBS with each other. Then they compared the frequencies of all pregnancy and child diagnoses in the first 2 years of life before and after maternal MBS with each other.ResultsA total of 53 813 women (median [IQR] age at surgery, 30 [26-35] years) were included, among 3686 women who had 1 pregnancy both before and after MBS. The study team found a significant increase in the small-for-gestational-age neonate rate after MBS (+4.4%) and a significant decrease in the large-for-gestational-age neonate rate (−12.6%). The study team highlighted that compared with pre-MBS births, after MBS births had fewer occurrences of gestational hypertension (odds ratio [OR], 0.16; 95% CI, 0.10-0.23) and gestational diabetes for the mother (OR, 0.39; 95% CI, 0.34-0.45), as well as fewer birth injuries to the skeleton (OR, 0.27; 95% CI, 0.11-0.60), febrile convulsions (OR, 0.39; 95% CI, 0.21-0.67), viral intestinal infections (OR, 0.56; 95% CI, 0.43-0.71), or carbohydrate metabolism disorders in newborns (OR, 0.54; 95% CI 0.46-0.63), but an elevated respiratory failure rate (OR, 2.42; 95% CI, 1.76-3.36) associated with bronchiolitis.Conclusions and RelevanceThe risk-benefit balance associated with MBS is highly favorable for pregnancies and newborns but may cause an increased risk of respiratory failure associated with bronchiolitis. Further studies are needed to better assess the middle- and long-term benefits and risks associated with MBS.

Is Maternal Metabolic Bariatric Surgery the Best Solution to Tackle the Childhood Obesity Pandemic?

“…To the Editor Few studies have studied child outcomes after maternal metabolic and bariatric surgery (MBS). Therefore, we read the study by Rives-Lange et al 1 We feel this recommendation is not fully supported by the current study and should be interpreted with caution. First, the study is missing crucial information from the participants on nutritional status, smoking habits, racial and socioeconomic background, fertility treatment, and most importantly on body mass index change between the pregnancies and gestational weight gain during pregnancy.…”

Special Delivery—Metabolic Bariatric Surgery as a Key Component of Maternal-Fetal Health Care

“…In this article, Rives-Lange and colleagues investigated the impact of MBS on obstetric, neonatal, and child outcomes (up to 2 years of age) by analyzing more than 3000 women in the French nationwide database who had pregnancies both before and after MBS. They found MBS was associated with improved fertility as well as significant decreases in many maternal and neonatal complications, including gestational diabetes, delivery of LGA infants, skeletal birth injuries, febrile convulsions, viral intestinal infections, and carbohydrate-metabolism disorders.…”

Errors in Figures and Author Affiliations

“…The Original Investigation titled “Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes After Metabolic and Bariatric Surgery,” published on November 9, 2022, was corrected to fix errors in Figures 2 and 3 and in the author affiliations. In Figures 2 and 3, footnotes a and b in panel A have been updated, and the labels in panel B have been updated.…”