Original Research
Obstetrics
Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center

https://doi.org/10.1016/j.ajog.2015.11.017Get rights and content

Background

Bariatric surgery is known to improve some pregnancy outcomes, but there is concern that it may increase the risk of small for gestational age.

Objective

To assess the impact of bariatric surgery on pregnancy outcomes and specifically of the type of bariatric surgery on the risk of fetal growth restriction.

Study Design

A single-center retrospective case-control study. The study group comprised all deliveries in women who had undergone bariatric surgery. To investigate the effects of weight loss on pregnancy outcomes, we compared the study group with a control group matched for presurgery body mass index. Secondly, to assess the specific impact of the type of surgery on the incidence of fetal growth restriction in utero, we distinguished subgroups with restrictive and malabsorptive bariatric surgery, and compared outcomes for each of these subgroups with a second control group, matched for prepregnancy body mass index.

Results

Among 139 patients operated, 58 had a malabsorptive procedure (gastric bypass) and 81 a purely restrictive procedure (72 a gastric banding and 9 a sleeve gastrectomy). Compared with controls matched for presurgery body mass index, the study group had a decreased rate of gestational diabetes (12% vs 23%, P = .02) and large for gestational age >90th percentile (11% vs 22%, P = .01) but an increased rate of small for gestational age <10th percentile. The incidence of small for gestational age was higher after gastric bypass (29%) than it was after restrictive surgery (9%) or in controls matched for prepregnancy body mass index (6%) (P < .01 between bypass and controls). In multivariable analysis, after adjustment for other risk factors, gastric bypass remained strongly associated with small for gestational age (adjusted odds ratio, 7.16; 95% confidence interval, 2.74–18.72).

Conclusion

Malabsorptive bariatric surgery was associated with an increased risk of fetal growth restriction.

Section snippets

Materials and Methods

This is a single-center retrospective case-control study. It was performed at Louis Mourier Hospital, in Colombes, France, a university center that includes both a level 3 maternity and a reference center for the treatment of obesity. We included all deliveries in women who had a history of bariatric surgery, whether they had been operated in the same center or elsewhere, between Jan 1, 2004 and Dec 31, 2013. Thirty-six patients were included in previous publications.17, 18, 19 In order to

Results

Between January 2004 and December 2013, 139 patients who underwent bariatric surgery were included in the study. Among them, 58 had a malabsorptive surgery (gastric bypass) and 81 a restrictive one (72 a gastric banding and 9 a sleeve gastrectomy). The mean interval between surgery and delivery was 38 months.

Principal findings

The most important finding in our study was a 2-fold increase in SGA associated with bariatric surgery, with a clear association between the type of procedure and SGA. Gastric bypass was an independent risk factor for fetal growth restriction, which persisted when adjusting for other risk factors in a multivariable analysis.

Bariatric surgery was also associated with a reduction in gestational diabetes and LGA, as reported in previous studies.9, 10, 14, 15, 16, 21 The rate of cesarean section

Acknowledgments

We thank Chloé Dussaux and Pietro Santulli for their participation in the conception of the study and data collection and thank the women who accepted that their data be used for the study.

References (30)

  • M.I. Blomberg et al.

    Maternal obesity and morbid obesity: the risk for birth defects in the offspring

    Birth Defects Res A Clin Mol Teratol

    (2010)
  • C.M. Boney et al.

    Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus

    Pediatrics

    (2005)
  • L. Sjöström et al.

    Bariatric surgery and long-term cardiovascular events

    JAMA

    (2012)
  • M.A. Maggard et al.

    Meta-analysis: surgical treatment of obesity

    Ann Intern Med

    (2005)
  • K. Johansson et al.

    Outcomes of pregnancy after bariatric surgery

    N Engl J Med

    (2015)
  • Cited by (0)

    The authors report no conflict of interest and no funding.

    Cite this article as: Chevrot A, Kayem G, Coupaye M, et al. Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol 2016;214:655.e1-7.

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