Skip to main content

Advertisement

SpringerLink
Log in

Maternal and Perinatal Outcomes After Bariatric Surgery: a Spanish Multicenter Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding the underlying maternal and perinatal risks are scarce. The objective of this nationwide study is to evaluate maternal and perinatal outcomes after BS.

Methods

We performed a retrospective observational study of 168 pregnancies in 112 women who underwent BS in 10 tertiary hospitals in Spain over a 15-year period. Maternal and perinatal outcomes, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders (PAHD), pre-term birth cesarean deliveries, small and large for gestational age births (SGA, LGA), still births, and neonatal deaths, were evaluated. Results were further compared according to the type of BS performed: restrictive techniques (vertical-banded gastroplasty, sleeve gastrectomy, and gastric banding), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD).

Results

GDM occurred in five (3 %) pregnancies and there were no cases of PAHD. Women whose pregnancies occurred before 1 year after BS had a higher pre-gestational body mass index (BMI) than those who got pregnant 1 year after BS (34.6 ± 7.7 vs 30.4 ± 5.3 kg/m2, p = 0.007). In pregnancies occurring during the first year after BS, a higher rate of stillbirths was observed compared to pregnancies occurring after this period of time (35.5 vs 16.8 %, p = 0.03). Women who underwent BPD delivered a higher rate of SGA babies than women with RYGB or restrictive procedures (34.8, 12.7, and 8.3 %, respectively).

Conclusions

Pregnancy should be scheduled at least 1 year after BS. Malabsorptive procedures are associated to a higher rate of SGA births.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.

    Article  PubMed  Google Scholar 

  2. Gutiérrez-Fisac JL, Guallar-Castillón P, León-Muñoz LM, et al. Prevalence of general and abdominal obesity in the adult population of Spain. 2008-2010: the ENRICA study. Obes Rev. 2012;13:388–92.

    Article  PubMed  Google Scholar 

  3. Berghöfer A, Pischon T, Reinhold T, et al. Obesity prevalence from a European perspective: a systematic review. BMC Public Health. 2008;8:200–10.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Nuthalapaty FS, Rouse DJ. The impact of obesity on obstetrical practice and outcome. Clin Obstet Gynecol. 2004;47:898–913.

    Article  PubMed  Google Scholar 

  5. ACOG practice bulletin (developed by the ACOG committee on Practice Bulletins). Bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405–13.

    Article  Google Scholar 

  6. Southern California Evidence-based Practice Center (EPC). Bariatric surgery in women of reproductive age: special concerns for pregnancy. Evidence report/technology assessment number 169.AHRQ publication no. 08-E013; 2008.

  7. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310:2416–25.

    PubMed Central  CAS  PubMed  Google Scholar 

  8. Metzger BE. Summary and recommendations of the Third International Workshop-conference on Gestational Diabetes Mellitus. Diabetes. 1991;40 suppl 2:197–201.

    Article  PubMed  Google Scholar 

  9. Carrascosa Lezcano A, Ferrández Longás A, Yeste Fernández D, et al. Estudio transversal español de crecimiento 2008. Parte I: valores de peso y longitud de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional. An Pediatr (Barc). 2008;68:544–51.

    Article  CAS  Google Scholar 

  10. Sheiner E, Balaban E, Dreiher J, et al. Pregnancy outcome in patients following different types of bariatric surgeries. Obes Surg. 2009;19:1286–92.

    Article  PubMed  Google Scholar 

  11. Aricha-Tamir B, Weintraub AY, Levi I, et al. Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery. Surg Obes Relat Dis. 2012;8:434–9.

    Article  PubMed  Google Scholar 

  12. Bebber FE, Rizzolli J, Schaan-Casagrande DS, et al. Pregnancy after bariatric surgery: 39 pregnancies follow-up in a multidisciplinary team. Obes Surg. 2011;21:1546–51.

    Article  PubMed  Google Scholar 

  13. Dell’Agnolo CM, De Barros Carvalho MD, Pelloso SM. Pregnancy after bariatric surgery: implications for mother and newborn. Obes Surg. 2011;21:699–706.

    Article  PubMed  Google Scholar 

  14. Sheiner E, Edri A, Balaban E, et al. Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery. Am J Obstet Gynecol. 2011;204:50.e1–e6.

    Article  Google Scholar 

  15. Wax JR, Cartin A, Wolff R, et al. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008;18:1517–21.

    Article  PubMed  Google Scholar 

  16. Patel JA, Patel NA, Thomas RL, et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:39–45.

    Article  PubMed  Google Scholar 

  17. Sapre N, Munting K, Pandita A, et al. Pregnancy following gastric bypass surgery: what is the expected course and outcome? N Z Med J. 2009;122:33–42.

    PubMed  Google Scholar 

  18. Pérez-Ferre N, Fernández D, Torrejón MJ, et al. Effect of lifestyle on the risk of gestational diabetes and obstetric outcomes in immigrant Hispanic women living in Spain. J Diabetes. 2012;4:432–8.

    Article  PubMed  Google Scholar 

  19. Ramos-Leví AM, Pérez-Ferre N, Fernández MD, et al. Risk factors for gestational diabetes mellitus in a large population of women living in Spain: implications for preventative strategies. Int J Endocrinol. 2012;2012:312529.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Duran A, Sáenz S, Torrejón MJ, et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: The St. Carlos Gestational Diabetes Study. Diabetes Care. 2014 [Epub ahead of print].

  21. Ricart W, López J, Mozas J, et al. Spanish group for the Study of the impact of Carpenter and Coustan GDM thresholds. Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain. Diabetologia. 2005;48:1135–41.

    Article  CAS  PubMed  Google Scholar 

  22. Lesko J, Peaceman A. Pregnancy outcomes in women after bariatric surgery compared with obese and morbidly obese controls. Obstet Gynecol. 2012;119:547–54.

    Article  PubMed  Google Scholar 

  23. Rao RS, Yanagisawa R, Kini S. Insulin resistance and bariatric surgery. Obes Rev. 2012;13:316–28.

    Article  CAS  PubMed  Google Scholar 

  24. Perez-Ferre N, Torrejon MJ, Fuentes M, et al. Association of low serum 25-hydroxyvitamin D levels in pregnancy with glucose homeostasis and obstetric and newborn outcomes. Endocr Pract. 2012;18:676–84.

    Article  PubMed  Google Scholar 

  25. Klebanoff MA, Koslowe PA, Kaslow R, et al. Epidemiology of vomiting in early pregnancy. Obstet Gynecol. 1985;66:612–6.

    CAS  PubMed  Google Scholar 

  26. Martínez-Frías ML, Bermejo E, Rodríguez-Pinilla E, et al. Secular evolution and evolution according to autonomous communities of the frequency of fertility treatments, multiple deliveries and cesarean sections in Spain [in Spanish]. Med Clin (Barc). 2005;124:132–9.

    Article  Google Scholar 

  27. Robinson HE, O’Connell CM, Joseph KS, et al. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106:1357–64.

    Article  PubMed  Google Scholar 

  28. García-Luna PP, Gonzalez-Navarro I. Pregnancy after bariatric surgery: what should we tell our patients? Endocrinol Nutr. 2014;61(2):65–7.

    Article  PubMed  Google Scholar 

  29. Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300:2286–96.

    Article  CAS  PubMed  Google Scholar 

  30. Marceau P, Kaufman D, Biron S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004;14(3):318–24.

    Article  PubMed  Google Scholar 

  31. Roos N, Neovius M, Cnattingius S, et al. Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study. BMJ. 2013;347:f6460.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Smith J, Cianflone K, Biron S, et al. Effects of maternal surgical weight loss in mothers on intergenerational transmission of obesity. J Clin Endocrinol Metab. 2009;94:4275–83.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank The Group of Obesity of the Spanish Society of Endocrinology and Nutrition (GOSEEN) for participating and providing data for this study, and Dr. Ana M Ramos-Leví for her valuable help in the preparation of this manuscript.

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Hospital Juan Ramón Jiménez, Ronda Exterior Norte s/n 21005, Huelva, Spain

    Irene González

  2. Hospital Clínico San Carlos, IDISSC, c/Profesor Martín Lagos, 28040, Madrid, Spain

    Miguel A. Rubio

  3. Hospital Universitario A Coruña, As Xubias, 15006, A Coruña, Spain

    Fernando Cordido

  4. Hospital Universitario Gregorio Marañón, Calle de Máiquez, 7, 28009, Madrid, Spain

    Irene Bretón

  5. Hospital del Meixoeiro, Meixoeiro s/n 36200, Vigo, Spain

    María J. Morales

  6. Hospital Universitario de Bellvitge, Feixa Llarga s/n 08907 L’Hospitalet de Llobregat, Barcelona, Spain

    Nuria Vilarrasa

  7. Hospital Universitario Gregorio Marañón, Calle de Máiquez,7, 28009, Madrid, Spain

    Susana Monereo

  8. Hospital Universitari Arnau de Vilanova, Avda. Rovira Roure 80, 25198, Lleida, Spain

    Albert Lecube

  9. Hospital de Sabadell, Parc Taulí, 1, 08208, Sabadell, Barcelona, Spain

    Assumptas Caixàs

  10. Hospital Clínic i Universitari, Calle Villarroel 170, 08036, Barcelona, Spain

    Irene Vinagre

  11. Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 08003, Barcelona, Spain

    Albert Goday

  12. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

    Albert Goday

  13. CIBERobn (Centros de Investigación Biomédica en Red—CIBER, Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain

    Albert Goday

  14. Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Sevilla, Spain

    Pedro P. García-Luna

Authors
  1. Irene González
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miguel A. Rubio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fernando Cordido
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Irene Bretón
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. María J. Morales
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nuria Vilarrasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Susana Monereo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Albert Lecube
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Assumptas Caixàs
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Irene Vinagre
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Albert Goday
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Pedro P. García-Luna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miguel A. Rubio.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

González, I., Rubio, M.A., Cordido, F. et al. Maternal and Perinatal Outcomes After Bariatric Surgery: a Spanish Multicenter Study. OBES SURG 25, 436–442 (2015). https://doi.org/10.1007/s11695-014-1387-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-014-1387-7

Keywords

Search

Navigation