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Post-op pregnancies

Post-op pregnancies should be classed as risk pregnancies

Credit: tipstimes.com/pregnancy
Women who had undergone surgery were much less likely to develop gestational diabetes

Bariatric surgery has both a positive and negative influence on the risk of complications during subsequent pregnancy and delivery, according to a study from Karolinska Institutet. The results, which are published in the New England Journal of Medicine, indicate that maternal health services should regard such cases as risk pregnancies.

“The effects of bariatric surgery on health outcomes such as diabetes and cardiovascular disease have been studied, but less is known about the effects on pregnancy and perinatal outcomes,” says the study’s lead author, Dr Kari Johansson from the Department of Medicine in Solna. “Therefore we wanted to investigate if the surgery influenced in any way the risk of gestational diabetes, preterm birth, stillbirth, if the baby was small or large for its gestational age, congenital malformations and neonatal death.”

Kari Johansson

Using data from nationwide Swedish health registries, the researchers identified 596 pregnancies to women who had given birth after bariatric surgery between 2006 and 2011. These pregnancies were then compared with 2,356 and matched to up to five control pregnancies for the mother’s pre-surgery BMI (using early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year.

The researchers found that the women who had undergone surgery were much less likely to develop gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; p<0.001) and give birth to large babies (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; p<0.001).

In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; p<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; p<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; p=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; p=0.06). There was no significant between-group difference in the frequency of congenital malformations.

“Since bariatric surgery followed by pregnancy has both positive and negative effects, these women, when expecting, should be regarded as risk pregnancies,” added Johansson. “They ought to be given special care from the maternal health services, such as extra ultrasound scans to monitor foetal growth, detailed dietary advice that includes checking the intake of the necessary post-surgery supplements.”

The study was financed by the Swedish Research Council, The Obesity Society, Karolinska Institutet and the Stockholm County Council.

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