Weight loss surgery raises odds of abdominal surgery during pregnancy

[April 14, 2017] By Shereen Lehman

(Reuters Health) - Women who have had bariatric surgery are six times more likely to need abdominal surgery during pregnancy compared to obese pregnant women who haven’t had a prior weight loss surgery, a recent study in Sweden suggests.

The most common reason for the abdominal surgeries was intestinal obstruction, a complication that affects 2 percent of all Swedish bariatric surgery patients, the authors note in Obstetrics and Gynecology.

Past research has found that bariatric surgery, such as gastric bypass, gastric banding and gastroplasty, is associated with increased risks during pregnancy of premature labor, cesarean delivery and delivering a baby that is small for gestational age.

Women may want to weigh the added risk of needing abdominal surgery during pregnancy when considering whether to wait until they have finished childbearing before having bariatric surgery, the study team writes.

Lead author Dr. Andrea Stuart, who specializes in obstetrics and gynecology at Central Hospital in Helsingborg, Sweden, told Reuters Health that she noticed some pregnant patients with previous gastric bypass surgery had clinical problems.

"They often presented with abdominal pain, and as intestinal obstruction could not be ruled out, they underwent abdominal surgery with a premature cesarean section," Stuart said by email.

Stuart and a colleague decided to study how bariatric surgery affected the risk of abdominal surgery during pregnancy by analyzing data from the Swedish National Patient Registry and the Swedish Medical Birth Registry for 1987 through 2011.

The researchers identified about 2,500 women who had undergone weight loss surgeries, usually gastric bypass, before giving birth, including about 1,200 first-time pregnancies, and compared them to more than 21,000 women who had a body mass index (BMI) in the obese range at the beginning of their pregnancies but no history of bariatric surgery.

The study team found that about 1.5 percent of pregnant women with a history of bariatric surgery also had abdominal surgery during their pregnancy due to intestinal obstruction, compared to 0.02 percent of women who did not have bariatric surgery.

Intestinal obstruction during pregnancy is potentially life-threatening for the mother and about 17 percent of fetuses die as a result, the study team writes. Pregnancy may increase the risk because of the extra pressure and organ displacement caused by the enlarged uterus.

An additional 1.5 percent of the pregnant women with prior bariatric surgery underwent surgical diagnostic procedures without finding any diagnosis, compared to 0.1 percent of pregnant women without prior bariatric surgery.

Many factors influence whether or not obese women should have bariatric surgery first or after childbearing, so there is no black or white answer, Stuart said. ”The factors include, the age of the women, duration of infertility, previous pregnancies, previous abdominal surgery, etc.”

However, it's important to note that obesity also raises risk factors for various problems during pregnancy. ”The maternal complications include gestational diabetes, preeclampsia and a higher risk of cesarean section,” Stuart said.

The fetal complications are, fetal miscarriage, malformations, high birth weight, cerebral palsy, asphyxia and death, she added.

SOURCE: http://bit.ly/2p8XNEo Obstetrics and Gynecology, online April 4, 2017.

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