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Maternal and fetal outcomes of Asian pregnancies after bariatric surgery
Sajid Malik1, Jun Liang Teh2, Davide Lomanto3
1Department of Surgery, National University Hospital, National University Health System, Singapore.
Insights
Bariatric surgery in morbidly obese Asian women reduces maternal complications but increases the risk of small for gestational age infants. Close fetal monitoring is crucial for Asian populations post-surgery.
Area of Science:
- Reproductive Medicine
- Bariatric Surgery Outcomes
- Maternal-Fetal Medicine
Background:
- Obesity is a significant risk factor for adverse pregnancy outcomes, including gestational diabetes and hypertensive disorders.
- Bariatric surgery effectively manages obesity but has been linked to potential fetal growth restriction.
Purpose of the Study:
- To evaluate maternal and fetal outcomes in morbidly obese Asian women following bariatric surgery.
- To compare outcomes with a matched control group of pregnancies.
Main Methods:
- Prospective cohort study of patients undergoing bariatric surgery.
- Comparison with a control group of 31 pregnancies matched for key demographic and clinical factors.
Main Results:
- The bariatric surgery group showed a trend towards lower rates of gestational diabetes (5.0% vs 19.3%) and significantly lower rates of pregnancy-induced hypertension/preeclampsia (0% vs 32.2%).
- However, the bariatric surgery group had a higher incidence of low birth weight infants (37.5% vs 9.4%).
- No predictors for small for gestational age fetuses were identified, and no growth retardation was observed in children with available follow-up data.
Conclusions:
- Bariatric surgery effectively reduces maternal comorbidities and the risk of large for gestational age infants.
- Asian women undergoing bariatric surgery face an elevated risk of small for gestational age pregnancies, necessitating vigilant fetal growth monitoring.
Introduction:
Obesity is a risk factor for pregnancy-induced hypertension, preeclampsia, gestational diabetes, and large gestational age pregnancy. Bariatric surgery is widely accepted to treat obesity but associated with small for gestational age fetuses.
Objective:
To report maternal and fetal outcomes after bariatric surgery in morbidly obese Asian females.
Setting:
University Hospital, Singapore.
Methods:
We maintain a prospective cohort of patients who underwent bariatric surgery in our institution. Maternal and fetal outcomes are compared with a control group of 31 pregnancies matched for age, parity, presurgery weight, and year of delivery.
Results:
Twenty-four pregnancies occurred in 16 patients in our postoperative cohort. Morbidly obese women in the control group were more likely to develop gestational diabetes (19.3% versus 5.0%, P = .150) and pregnancy-induced hypertension/preeclampsia (32.2% versus 0%, P = .003) compared with the postoperative group. Of fetuses, 37.5% in the bariatric group had low birth weight compared with only 9.4% fetuses in the control group (P = .016). Preoperative body mass index, short interval between conception and surgery, and poor weight gain during pregnancy did not predict for small for gestational age fetuses. Subsequent weights were available for 37.5% of the children in the surgical cohort and none of these children exhibited growth retardation.
Conclusion:
Bariatric surgery lowers the risk of maternal co-morbidities and large gestational age fetus during pregnancy. Asians are at high risk of small for gestational age pregnancies after bariatric surgery and should undergo close monitoring for fetal growth throughout their pregnancy.
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