NEW YORK (Reuters Health) – Some maternal and perinatal outcomes may be better in obese women who undergo laparoscopic sleeve gastrectomy (LSG) than in their obese peers who are not treated with bariatric surgery, new research shows.
Women who underwent the procedure were at lower risk of gestational diabetes mellitus (GDM), excessive fetal growth and cesarean delivery compared to a control group of women matched by pre-surgery body-mass index (BMI), Dr. Uriel Elchalal of Hadassah-Hebrew University Medical Center in Jerusalem and colleagues found.
The women who underwent LSG were, however, at increased risk for having small for gestational age (SGA) and low-birth-weight babies, the authors report in Obstetrics & Gynecology, online February 5.
“Numerous studies have evaluated pregnancy outcomes following bariatric surgery,” Dr. Elchalal noted in an email interview with Reuters Health. “However, as these studies almost exclusively included patients who underwent either gastric bypass or gastric banding, there is limited information regarding pregnancy outcomes following sleeve gastrectomy, which is now the most commonly performed bariatric procedure in the U.S. and Europe.”
In their retrospective study, Dr. Elchalal and his team compared 119 women (mean age, 32) who had undergone LSG and 119 who had not undergone any bariatric surgery. In the LSG group, the median BMI was 41.7 preoperatively and 28.9 postoperatively. The median time from surgery to conception was 508 days.
GDM occurred in 3.4% of LSG patients and 17.6% of controls; rates of having a large-for-gestational-age newborn were 1.7% and 19.3%, respectively. Less than 1% of the LSG group had a baby weighing more than 4,000 grams, versus 7.6% of the control group. Cesareans were performed in 10% of the LSG group and 20% of the control group. All of these differences were statistically significant.
In all, 14.3% of the women who underwent LSG had an SGA infant, versus 4.2% of controls; rates of low birth weight were 12.6% and 4.2% in the two groups, respectively. Both differences were statistically significant.
The median hemoglobin level, both in early pregnancy and at delivery, was lower in the post-LSG group than in controls.
“The increased rates of SGA infants and anemia among post sleeve gastrectomy patients highlight the need for strict surveillance of fetal growth and hemoglobin levels throughout pregnancy,” Dr. Elchalal said. “While this finding is consistent with studies that examined post-gastric bypass, it challenges the presumption that the observed risk of impaired fetal growth is due to malabsorption and suggests that other factors may be involved.”
He and his colleagues are conducting experimental studies to better understand the pathogenesis of SGA after bariatric surgery.
“As 80% of patients who undergo bariatric surgery are women of childbearing age, coupled with the rapidly growing utilization of bariatric procedures in the management of obesity, obstetricians are increasingly likely to encounter women who have undergone bariatric surgery in their routine practice,” Dr. Elchalal said. “Therefore, practitioners should be familiar with this rapidly growing group of patients in order to improve patient management and outcomes.”
SOURCE: http://bit.ly/2EyTFZu
Obstet Gynecol 2018.
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