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Neonatal Outcomes and the Risk of Congenital Anomalies After Maternal Bariatric Surgery
William G Lee1, Aaron M Barkhordar1, Candace Levian2
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Insights
Maternal bariatric surgery impacts pregnancy outcomes. Malabsorptive procedures increase maternal anemia and low birth weight infants, while conception within one year of surgery raises congenital anomaly risks.
Area of Science:
- Obstetrics and Gynecology
- Bariatric Surgery Outcomes
- Neonatal Health
Background:
- Maternal history of bariatric surgery (MHBS) is linked to adverse pregnancy and neonatal outcomes.
- Limited data exist on how bariatric procedure type and timing influence these outcomes.
Purpose of the Study:
- To evaluate the impact of bariatric procedure type (restrictive vs. malabsorptive) and timing to conception on congenital anomalies and neonatal outcomes.
- To inform obstetric counseling and nutritional monitoring for pregnant patients with MHBS.
Main Methods:
- Retrospective cohort study of 130 infants born to mothers with MHBS (2012-2022).
- Comparison of outcomes based on bariatric procedure type and conception timing (≤1 year vs. >1 year post-surgery).
- Statistical analysis using Chi-Square, Fisher's Exact, and Mann-Whitney U tests.
Main Results:
- Malabsorptive procedures were associated with higher rates of maternal anemia (54.9%) and nutritional deficiency (31.4%), and low birth weight infants (27.5%).
- Conception within one year of surgery correlated with increased fetal growth restriction (27.3%) and congenital anomalies (54.5%).
- No significant difference in congenital anomalies was observed between restrictive and malabsorptive procedure groups.
Conclusions:
- Malabsorptive bariatric procedures increase risks for maternal anemia, nutritional deficiencies, and low birth weight infants.
- Conceiving within one year of bariatric surgery is linked to higher rates of congenital anomalies.
- Close nutritional monitoring and timely obstetric counseling are crucial for pregnancies following bariatric surgery, especially within the first year.
Introduction:
Maternal history of bariatric surgery (MHBS) has been previously linked to higher rates of congenital anomalies and poor neonatal outcomes. However, limited data exist on the impact of bariatric procedure type and timing from MHBS to conception.
Methods:
A retrospective cohort study evaluated infants born between January 1, 2012, and December 31, 2022 to mothers with a history of prior bariatric surgery. Rates of congenital anomalies and neonatal outcomes were compared by bariatric procedure type (restrictive versus malabsorptive) and timing from surgery to conception (≤1 y versus >1 y) using Chi-Square, Fisher's Exact, and Mann-Whitney U tests; significance P < 0.05.
Results:
One hundred thirty infants were born to patients with an MHBS. Restrictive bariatric procedures included gastric banding (28.7%) and sleeve gastrectomy (32.0%), and malabsorptive procedures included Roux-en-Y gastric bypass (39.3%). Maternal patients who previously underwent a malabsorptive procedure were more likely to be anemic (54.9% versus 29.1%, P = 0.003), have a nutritional deficiency during pregnancy (31.4% versus 15.2%, P = 0.028), or deliver an infant with low birth weight (27.5% versus 8.9%, P = 0.005). Infants conceived ≤1 y from surgery exhibited higher rates of fetal growth restriction (27.3% versus 2.5%, P < 0.001) and congenital anomalies (54.5% versus 22.7%, P = 0.02).
Conclusions:
Mothers who underwent a malabsorptive bariatric procedure experienced higher rates of anemia, nutritional deficiency, and infants with low birth weight, but no difference in congenital anomalies compared to the restrictive cohort. Infants conceived ≤1 y from surgery experienced higher rates of congenital anomalies. These findings suggest the importance of close nutritional monitoring and obstetric counseling in the first year following bariatric surgery.
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