Women who have undergone weight-loss surgery and go on to become pregnant should be given extra care by their health services.
Although women derive many benefits after having bariatric surgery, health services should regard them as higher risk in pregnancy, a new study from the Karolinska Institutet in Sweden warns.
The research, which is published in the New England Journal of Medicine reveals that there has been a sharp rise in the number of women becoming pregnant after bariatric surgery: in 2013 almost 8,000 such operations were performed in Sweden, 80% of which were on women.
“The effects of bariatric surgery on health outcomes such as diabetes and cardiovascular disease have been studied, but less is known about the effects on pregnancy and perinatal outcomes,” said Dr Kari Johansson, the study’s lead author who works at the Department of Medicine in Solna.
“Therefore we wanted to investigate if the surgery influenced in any way the risk of gestational diabetes, preterm birth, stillbirth, if the baby was small or large for its gestational age, congenital malformations and neonatal death.”
The research team identified 596 pregnancies among women who had given birth after bariatric surgery between 2006 and 2011.
These pregnancies were then compared with 2,356 pregnancies to women who had not been operated upon but who had the same body mass index (BMI, weight divided by height squared) as the first group prior to surgery.
They found that women who had undergone surgery were much less likely to develop gestational diabetes – just 2% compared to 7% – and give birth to large babies.
Just over 22% of women in the comparison group had babies that were large for gestational age, compared with just under barely 9% of the women who’d had surgery.
However, the women in the bariatric surgery group were twice as likely to give birth to babies who were small for gestational age. The pregnancies were also shorter.
“Since bariatric surgery followed by pregnancy has both positive and negative effects, these women, when expecting, should be regarded as risk pregnancies,” says Dr Johansson.
“They ought to be given special care from the maternal health services, such as extra ultrasound scans to monitor foetal growth, detailed dietary advice that includes checking the intake of the necessary post-surgery supplements.”
Johansson K, Cnattingius S et al. Outcomes of Pregnancy in Women with Prior Bariatric Surgery. New England Journal of Medicine 26 February 2015
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