Bariatric Surgery Before Pregnancy Could Reduce Complications

If you are currently obese and you are considering having a child you might want to think about bariatric surgery before conception. It has been shown that by having this procedure prior to pregnancy could reduce the risks of neonatal and maternal complications during pregnancy and have a better chance to result in a healthy and happy infant.

Obesity has climbed to “epidemic” levels and over the past ten years, the rate of women that are of reproductive age having bariatric surgery has risen. Bariatric surgery could change fertility after the weight loss or alter nutritional requirements during pregnancy. With the growing number of women of childbearing age having undergone bariatric surgery, there is a need for guidance and information about fertility, pregnancy, and contraception.

To estimate the rates of bariatric surgery among women ages 18 to 45 and to assess the surgery’s impact on fertility and pregnancy outcomes, the researchers conducted a literature review of 75 studies that were published between the year 1985 and February 2008. The review found that the rates of pre-eclampsia and gestational diabetes were significantly lower for women who had the weight-loss surgery. Also, the risk of premature birth and a low birth weight were similar or better for the surgery patients, said Melinda A. Maggard, M.D. from the University of California Los Angeles.

The researchers obtained studies from the Nationwide Inpatient Sample (1998-2005) and multiple electronic databases that included Controlled Clinical Trials Register Database, Medline, Cochrane Database of Reviews of Effectiveness, and EMBASE. In the analysis, they found that the incidence of bariatric surgery in the United States increased approximately 800% between the years 1998 and 2005, and women account for approximately 83% of the procedures among the ages 18 and 45. Sixteen of these studies examined pregnancies following the bariatric surgery.

Three specific studies showed lower maternal complication rates after the bariatric surgery compared with those for obese women that did not have the surgery. One of these studies focused only on laparoscopic adjustable gastric band surgery and found the rates of gestational diabetes and preeclampsia were lower in the group that had the bariatric surgery. The other thirteen studies supported this finding as well. Fourteen of the studies analyzed the neonatal outcomes following bariatric surgery. The four most commonly outcomes that were observed included low birth weight, perinatal mortality, premature delivery, and macrosomia. The researchers stated that there is no evidence that adverse neonatal outcome rates are higher following gastric bypass or laparoscopic surgeries.

In the study of the laparoscopic surgeries, neonatal outcomes were very similar or better for the laparoscopic patients. Also, there were no differences in neonatal outcomes after the gastric bypass surgery.

Although the researchers said that there were too few studies to draw sufficient conclusions on caesarean delivery, nutrition, fertility, and contraception, they did find that the rates of miscarriage could be higher among patients that undergo biliopancreatic diversion. Also, they found severe nutritional deficiencies in pregnancies that followed this procedure.

Most of the studies attributed this deficiency to nonadherence, because the women are typically instructed to take vitamin supplements following their surgery. The researchers stated that studies of consecutive patients that systematically monitor adherence and nutritional statues need to be conducted.

This review found that the relationship between fertility and bariatric surgery has not been very well studied, but the researchers made one inference, stating, “Reports of normalization of sex hormones, menstrual irregularities, and improvement in polycystic ovarian syndrome following surgery suggest that fertility may improve,” but many of these studies were limited by selection bias.

Though the researchers report was limited by the quality of the original studies, they concluded that “research is needed to better delineate the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes." In other words, they  have made a case for further research into the matter.