Laparoscopic sleeve gastrectomy and pregnancy outcomes: A systematic review

Obesity is a chronic disease that presents a significant prevalence among women within childbearing age. Laparoscopic sleeve gastrectomy (LSG) is a widely used method for the treatment of obesity. Several studies have examined this operation's impact on pregnancy outcomes with contradictory results. The aim of this systematic review was to examine the maternal and neonatal outcomes following LSG. The electronic databases of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus as well as grey literature from inception to December 2019 were systematically reviewed. Search strategy included the terms: "sleeve" "gastrectomy" and "pregnancy". Eligibility criteria were randomized control trials, cohort studies and case series that reported on women with LSG prior to conception and maternal and neonatal outcomes. A total of 406 distinct articles were identified with nine studies included in the systematic review. A cumulative statistical analysis reported a preoperative BMI of 43.6 ± 5.0 kg/m2 while BMI at conception was 29.6 ± 4.9 kg/m2. The average weight gain during pregnancy was 8.9 kg. Preeclampsia appeared in 2.7 %, gestational diabetes (GD) in 5.7 % and cesarean delivery was performed at 42.5 %. Small for gestational age (SGA) neonates were diagnosed in 15.8 % and large for gestational age (LGA) neonates in 3.7 %. Limited data exist on the subject and further prospective studies are needed to prove the exact evidence of relation between LSG and pregnancy outcomes. Initial studies show that patients with LSG present lower rates of GD and LGA neonates, higher rates of SGA neonates and similar rates of hypertensive disorders and prematurity when compared to non operated controls. Time interval between LSG and conception is not proven to have a statistically significant impact on maternal or neonatal outcomes.