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 Compared to obese women who didn't have so-called bariatric surgery,
women who did were less likely to develop diabetes during pregnancy
and less likely to deliver overly large babies, researchers report
in The New England Journal of Medicine.
However, the women who had surgery were more likely to have shorter
pregnancies and to deliver smaller-than-normal babies. There was
also a possible link to increased risk of stillbirth and neonatal
death among the babies of women who had the surgery.
Bariatric surgery "has both positive and negative influences on the
risk of complications during a subsequent pregnancy,” said Kari
Johansson, the study’s lead author from the Karolinska Institute in
Stockholm.
Johansson cautioned in her email to Reuters Health that the study
shows ties between weight-loss surgery and pregnancy outcomes, but
doesn’t prove cause and effect.
Weight-loss surgery reduces the size of the stomach, and in some
cases bypasses part of the digestive tract.
While it’s known that women who are overweight or obese have more
pregnancy complications, the researchers say there is little
information about pregnancy after weight-loss surgery.
Their new study involved nearly 3,000 Swedish pregnancies between
2006 and 2011 - including 596 in women who had weight-loss surgery
within the previous five years, and another 2356 in women whose
pre-pregnancy weight was similar to what the weight-loss surgery
patients had weighed before their surgery.
Overall, there was no difference between the two groups in the risk
of going into labor early. Also, there was no difference in the risk
for birth defects.
Only about 2 percent of women in the surgery group developed
diabetes during pregnancy, compared to about 7 percent in the
non-surgery group. Also, about 9 percent of women in the surgery
group delivered overly large babies, compared to about 22 percent of
the non-surgery group.
But about 16 percent of women in the surgery group gave birth to
smaller-than-normal babies, compared to about 8 percent of women in
the non-surgery group. Also, the women who had surgery had
pregnancies lasting 273 days, compared to about 278 days among the
women who didn’t have surgery. Both of those durations are within
the normal range, however.
The researchers also found that about 2 percent of pregnancies after
weight-loss surgery ended in stillbirths or the death of infants
within the first month of life, compared to about 1 percent of
pregnancies in women who didn’t have surgery.
The researchers can’t say whether the increased risk of stillbirth
or infant death was simply by chance, however.
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“We therefore do not have a large enough sample to give any clear
answer about this,” Johansson said. “This outcome needs to be
studied further in even larger samples of patients.”
In an editorial, Dr. Aaron Caughey of Oregon Health and Science
University in Portland wrote that other factors could influence
complication rates, include complications during previous
pregnancies.
Dr. Loralei Thornburg, who wasn’t involved in the new study, also
pointed out that 98 percent of the women who had weight-loss surgery
had the procedure that bypasses part of the small intestine.
“I think we have to interpret the findings with caution for
different types of surgeries,” said Thornburg, who is a high-risk
pregnancy expert at the University of Rochester Medical Center in
New York.
She also said the study did not focus on many outcomes that may be
better for mothers after weight-loss surgery, including their risk
of death.
Thornburg, who said her center sees many women after weight-loss
surgery, said women should always have discussions with their
doctors before becoming pregnant – procedure or not.
She said women who had the surgery may need additional counseling
about nutrition, care around remaining excess weight and possibly
more monitoring. Additionally, they should talk about fertility
before their surgery, she said.
“You should absolutely talk to your doctor,” Thornburg said.
“Everyone should strive to be at a healthy weight and in a healthy
lifestyle before they enter pregnancy.”
SOURCE: http://bit.ly/1zffE8V The New England Journal of Medicine,
online February 25, 2015.
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reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
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