Bariatric Surgery, Gestational Diabetes and Perinatal Outcomes: A Population-Based Study

Area of Science:

• Reproductive Health
• Maternal-Fetal Medicine
• Endocrinology

Background:

• Gestational diabetes mellitus (GDM) affects a significant portion of pregnancies.
• Metabolic and bariatric surgery (MBS) is increasingly common, impacting women of reproductive age.
• Understanding the combined effects of GDM and MBS on pregnancy is critical for optimizing maternal and neonatal care.

Purpose of the Study:

• To investigate the independent and combined associations of GDM and MBS with adverse maternal and neonatal outcomes.
• To identify specific risks conferred by GDM and MBS, both individually and together.
• To inform personalized antenatal care strategies for high-risk pregnancies.

Main Methods:

• Population-based retrospective cohort study utilizing linked perinatal and hospital data from New South Wales, Australia (2016-2020).
• Included 429,576 singleton births, with 3,001 women having a history of MBS.
• Multivariable logistic regression analyzed associations between GDM, MBS, and outcomes, adjusting for key covariates.

Main Results:

• Women with both GDM and prior MBS exhibited the highest odds of adverse outcomes, including large-for-gestational-age (LGA) infants, preterm birth, and neonatal hypoglycemia.
• Compared to women without GDM or MBS, the GDM/MBS group had significantly increased odds of LGA (aOR 1.42), preterm birth (aOR 1.93), and neonatal hypoglycemia (aOR 4.98).
• Preeclampsia risk was modestly increased across exposed groups, while postpartum hemorrhage was reduced in women with prior MBS.

Conclusions:

• Gestational diabetes mellitus (GDM) and prior metabolic and bariatric surgery (MBS) independently and synergistically increase the risk of adverse perinatal outcomes.
• These findings underscore the necessity of tailored antenatal surveillance and management for pregnant individuals with a history of GDM and MBS.
• Personalized care strategies are essential to mitigate risks and improve outcomes in this high-risk obstetric population.