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Published on: November 14, 2020
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Perinatal Outcomes After Sleeve Gastrectomy Compared to a Matched Control Group
Amy Ngov1, James Elhindi2,3, Caron Blumenthal1
1Department of Obstetrics and Gynaecology, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia.
Summary
Pregnancy after sleeve gastrectomy (SG) is common, but outcomes vary. While SG reduces risks of gestational diabetes and hypertension, it increases the risk of small-for-gestational-age (SGA) infants, necessitating careful monitoring.
Area of Science:
- Bariatric surgery outcomes
- Maternal-fetal medicine
- Reproductive health
Background:
- Pregnancy following sleeve gastrectomy (SG) is increasingly prevalent.
- Limited data exists on perinatal outcomes after SG.
- Understanding these outcomes is crucial for clinical management.
Purpose of the Study:
- To compare perinatal outcomes in pregnancies after sleeve gastrectomy versus a matched non-bariatric control group.
- To identify specific risks and benefits associated with pregnancy post-SG.
- To inform clinical guidelines for managing pregnancies after bariatric surgery.
Main Methods:
- Retrospective cohort study of 469 post-SG pregnancies and 915 matched controls (2016-2022).
- Matching criteria included maternal age, pre-pregnancy BMI, parity, smoking, and delivery year.
- Outcomes assessed included gestational diabetes, hypertension, infant size (LGA/SGA), perinatal mortality, preterm birth, neonatal admission, congenital anomalies, and caesarean births.
Main Results:
- Post-SG pregnancies showed significantly lower rates of gestational diabetes (5.4% vs 16.6%), gestational hypertension/preeclampsia (1.1% vs 6.1%), large-for-gestational-age infants (6.0% vs 14.1%), and neonatal unit admission (13.9% vs 19.0%).
- Conversely, pregnancies post-SG had a nearly doubled risk of small-for-gestational-age (SGA) infants (14.5% vs 8.3%).
- A surgery-to-pregnancy interval under 12 months was linked to inadequate gestational weight gain but not other adverse outcomes.
Conclusions:
- Pregnancy following sleeve gastrectomy is associated with an increased risk of small-for-gestational-age (SGA) infants, potentially due to nutrient deficiencies or unrecognized hypoglycemia.
- Enhanced patient education, diligent nutrient monitoring and supplementation, and increased fetal surveillance are recommended for pregnancies post-SG.
- These measures are vital for optimizing maternal and infant outcomes in this growing patient population.
