Background
Bariatric surgery is a widely used treatment option for obesity that often provides
long-term weight control and health benefits. Although a growing number of women are
becoming pregnant after bariatric surgery, only a few population-based studies have
assessed the impact thereof on perinatal outcomes.
Objective
This study aimed to examine the association between bariatric surgery and adverse
perinatal outcomes in pregnant women and to examine whether the risk for adverse perinatal
outcomes is modified by the postsurgery weight, gestational weight gain, type of bariatric
surgery, timing of pregnancy after bariatric surgery, and maternal comorbidities.
Study Design
A retrospective cohort study was performed with the use of the Bariatric Surgery Registry
and hospital inpatient and outpatient physician encounter records. The International
Classification of Diseases, Ninth and Tenth Revision codes from hospitalizations during
pregnancy and infant birth records were used to ascertain the outcomes of interest.
Women eligible for BS who delivered at ≥20 weeks of gestation (n=20,213) at Kaiser
Permanente Southern California hospitals (January 1, 2007 to December 31, 2018) were
included in the study. Adjusted odds ratios were derived from logistic regression
models with inverse probability of treatment weighting to adjust for confounding using
propensity scores.
Results
Bariatric surgery was associated with a reduction in the risks for gestational diabetes
(adjusted odds ratio, 0.60; 95% confidence interval, 0.53–0.69; P<.001), preeclampsia (adjusted odds ratio, 0.53; 95% confidence interval, 0.46–0.61;
P<.001), chorioamnionitis (adjusted odds ratio, 0.45; 95% confidence interval, 0.32–0.63;
P<.001), cesarean delivery (adjusted odds ratio, 0.65; 95% confidence interval, 0.59–0.72;
P<.001), large for gestational age neonate (adjusted odds ratio, 0.23; 95% confidence
interval, 0.19–0.29; P<.001), macrosomia (adjusted odds ratio, 0.24; 95% confidence interval, 0.19–0.30;
P<.001), and neonatal intensive care unit admission (adjusted odds ratio, 0.70; 95%
confidence interval, 0.61–0.81; P<.001). However, bariatric surgery was also associated with a significantly increased
risk for small for gestational age neonates (adjusted odds ratio, 2.46; 95% confidence
interval, 2.16–2.79; P<.001). The risk for the adverse outcomes is independent of the time interval between
the surgery and subsequent pregnancy.
Conclusion
These data suggest that there are many pregnancy outcome benefits for women with severe
obesity who undergo bariatric surgery; however, women who have undergone bariatric
surgery before pregnancy should be monitored closely to reduce the risk for small
for gestational age neonates and postpartum hemorrhage.
Key words
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Article info
Publication history
Published online: June 30, 2021
Accepted:
June 25,
2021
Received in revised form:
June 3,
2021
Received:
February 26,
2021
Footnotes
The authors report no conflict of interest.
This study was funded by the Kaiser Permanente Direct Community Benefit funds. The funding body did not influence the design or conduct of the study; analysis or interpretation of the data; or the preparation, review, or approval of the manuscript.
Cite this article as: Getahun D, Fassett MJ, Jacobsen SJ, et al. Perinatal outcomes after bariatric surgery. Am J Obstet Gynecol 2022;226:121.e1-16.
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