Dr Jade Eccles-Smith2,3, Dr Alison Griffin4, Professor H. David McIntyre5,6, A/Prof. Marloes Dekker Nitert1, A/Prof Helen Barrett7,8
1School of Chemistry and Molecular Biosciences, The University Of Queensland, St Lucia, Australia, 2Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, Australia, 3Mater Research Institute, The University of Queensland, South Brisbane, Australia, 4QIMR Berghofer Medical Research Institute, Herston, Australia, 5Faculty of Medicine, The University of Queensland, South Brisbane, Australia, 6Obstetric Medicine, Mater Health, South Brisbane, Australia, 7Obstetric Medicine, Royal Hospital for Women, Randwick, Australia, 8Faculty of Medicine, University of New South Wales, Sydney, Australia
Biography:
A/Prof Barrett is the Director of Obstetric Medicine at the Royal Hospital for Women in Sydney. She conducts her research on bariatric surgery in pregnancy within the University of New South Wales. A/Prof Barrett is a past president of SOMANZ.
Abstract:
In Australia, bariatric procedures doubled between 2005 and 2015 with 80% performed on women of childbearing age. The ideal time interval from surgery to pregnancy is controversial, current recommendations are >12 months to minimize the theoretical risks of malnutrition and impaired fetal growth (1, 2). Maternal and fetal outcomes however are heterogenous. This data-linkage project analysed the pregnancy and neonatal outcomes of women with a pre-pregnancy bariatric surgery to conception interval of <12 months and ≥12 months.
A statewide hospital and perinatal data register linked cohort matched study was performed.
A total of n=1282 singleton, first pregnancies following bariatric surgery were analyzed with n=383 surgery to conception interval of <12 months and n=899 ≥12 months. Continuous variables were analyzed using paired t-tests and categorical variables with Chi-square or Fishers exact tests.
Women with a surgery to conception interval of <12 months were likely to be younger (p<0.001) and multiparous (12.7% vs 26.2%;p<0.001) than women who conceived ≥12 months of surgery. They were also less likely to have gestational diabetes mellitus (GDM) (11% vs 16.8%;p=0.01) or pregnancy-induced hypertension (1.8% vs 4.4%;p=0.02) but had more nausea and vomiting of pregnancy (3.9% vs 1.4%;p=0.01). Their infants had lower absolute birthweights (3160g (2860-3510) vs 3270g (2970-3610);p=0.001), lower rates of large for gestational age (LGA) (6.8% vs 9.3%; p=0.049) but no difference in rates of small for gestational age (SGA). There were no differences in pre-term delivery, neonatal nursery admission or congenital anomalies between groups.
Our results suggest that pregnancy outcomes following a surgery to conception interval of <12 months differ from those ≥12 months. Reassuringly, rates of congenital anomalies, SGA, pre-term delivery and neonatal nursery admissions were not different between groups. Gestational weight gain may contribute to the alterations in pregnancy and neonatal outcomes, however physiologic adaptations following surgery may also be involved.
Keywords
Bariatric Surgery, pregnancy outcomes, small for gestational age
References
1. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American association of clinical endocrinologists, The obesity society, and American society for metabolic & bariatric surgery*. Obesity. 2013;21(S1):S1-S27.
2. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2010;95(11):4823-43.