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Published in: Obesity Surgery 11/2018

01-11-2018 | Original Contributions

Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes

Authors: Cátia Rasteiro, Célia Araújo, Sara Cunha, Rita Caldas, Joana Mesquita, Adérito Seixas, Nuno Augusto, Carla Ramalho

Published in: Obesity Surgery | Issue 11/2018

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Abstract

Introduction

Pregnancy in women submitted to bariatric surgery is increasing. Recommendations for surveillance of these pregnancies have been suggested, but an adequate time interval from surgery to conception, to avoid perinatal negative outcomes, is still controversial.

Material and Methods

Medical records of pregnancies in women with previous bariatric surgery were retrieved and outcomes were assessed according to three different time thresholds (12, 18 and 24 months). The association between time from surgery to conception and the presence of adverse outcomes was analysed.

Results

Eighty-six pregnancies were assessed. Weight gain was higher (p = 0.014) and more adequate (p = 0.041) when pregnancy occurred more than 12 months after surgery. Foetal growth percentile was lower when pregnancy was achieved before 24 months following surgery (p = 0.021). No differences among groups were found in other assessed outcomes (BMI, gestational age at delivery, type of delivery, gestational diabetes, pregnancy hypertensive disease, anaemia, preterm delivery, foetal weight, foetal growth restriction, Apgar score, admission to neonatal intensive unit) in all considered thresholds. No association between time from surgery to conception and the presence of adverse outcomes was found.

Conclusion

Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.
Literature
1.
go back to reference Organisation for Economic Co-operation and Development. Obesity Update 2017. 2017. Organisation for Economic Co-operation and Development. Obesity Update 2017. 2017.
2.
go back to reference do Carmo I, Dos Santos O, Camolas J, et al. Overweight and obesity in Portugal: national prevalence in 2003-2005. Obes Rev. 2008;9(1):11–9.PubMed do Carmo I, Dos Santos O, Camolas J, et al. Overweight and obesity in Portugal: national prevalence in 2003-2005. Obes Rev. 2008;9(1):11–9.PubMed
3.
go back to reference Sardinha LB, Santos DA, Silva AM, et al. Prevalence of overweight, obesity, and abdominal obesity in a representative sample of Portuguese adults. PLoS One. 2012;7(10):e47883.CrossRefPubMedPubMedCentral Sardinha LB, Santos DA, Silva AM, et al. Prevalence of overweight, obesity, and abdominal obesity in a representative sample of Portuguese adults. PLoS One. 2012;7(10):e47883.CrossRefPubMedPubMedCentral
4.
go back to reference Mission JF, Marshall NE, Caughey AB. Pregnancy risks associated with obesity. Obstet Gynecol Clin N Am. 2015;42(2):335–53.CrossRef Mission JF, Marshall NE, Caughey AB. Pregnancy risks associated with obesity. Obstet Gynecol Clin N Am. 2015;42(2):335–53.CrossRef
5.
go back to reference Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed
6.
go back to reference Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.CrossRefPubMed Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.CrossRefPubMed
7.
go back to reference Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018;218(6):573–80.CrossRefPubMed Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018;218(6):573–80.CrossRefPubMed
8.
go back to reference Kassir R, Goiset MP, Williet N, et al. Bariatric surgery and pregnancy: what outcomes? Int J Surg. 2016;36(Pt A):66–7.CrossRefPubMed Kassir R, Goiset MP, Williet N, et al. Bariatric surgery and pregnancy: what outcomes? Int J Surg. 2016;36(Pt A):66–7.CrossRefPubMed
9.
go back to reference Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(9):814–24.CrossRefPubMed Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(9):814–24.CrossRefPubMed
10.
go back to reference American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113(6):1405–13.CrossRef American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113(6):1405–13.CrossRef
11.
go back to reference Alatishe A, Ammori BJ, New JP, et al. Bariatric surgery in women of childbearing age. QJM. 2013;106(8):717–20.CrossRefPubMed Alatishe A, Ammori BJ, New JP, et al. Bariatric surgery in women of childbearing age. QJM. 2013;106(8):717–20.CrossRefPubMed
12.
go back to reference Apovian CM, Baker C, Ludwig DS, et al. Best practice guidelines in pediatric/adolescent weight loss surgery. Obes Res. 2005;13(2):274–82.CrossRefPubMed Apovian CM, Baker C, Ludwig DS, et al. Best practice guidelines in pediatric/adolescent weight loss surgery. Obes Res. 2005;13(2):274–82.CrossRefPubMed
13.
go back to reference Monteiro M. Comment on: pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. Surg Obes Relat Dis. 2017;13(11):1905–7.CrossRefPubMed Monteiro M. Comment on: pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. Surg Obes Relat Dis. 2017;13(11):1905–7.CrossRefPubMed
14.
go back to reference Royal College of Obstetricians & Gynaecologists. The role of bariatric surgery in improving reproductive health. 2015. Royal College of Obstetricians & Gynaecologists. The role of bariatric surgery in improving reproductive health. 2015.
15.
go back to reference Carreau A-M, Nadeau M, Marceau S, et al. Pregnancy after bariatric surgery: balancing risks and benefits. Can J Diabetes. 2017;41(4):432–8.CrossRefPubMed Carreau A-M, Nadeau M, Marceau S, et al. Pregnancy after bariatric surgery: balancing risks and benefits. Can J Diabetes. 2017;41(4):432–8.CrossRefPubMed
16.
go back to reference Menard MK, Kilpatrick S, Saade G, et al. Levels of maternal care. Am J Obstet Gynecol. 2015;212(3):259–71.CrossRefPubMed Menard MK, Kilpatrick S, Saade G, et al. Levels of maternal care. Am J Obstet Gynecol. 2015;212(3):259–71.CrossRefPubMed
17.
go back to reference Moore KA, Ouyang DW, Whang EE. Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med. 2004;351(7):721–2.CrossRefPubMed Moore KA, Ouyang DW, Whang EE. Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med. 2004;351(7):721–2.CrossRefPubMed
18.
go back to reference Kjær MM, Nilas L. Timing of pregnancy after gastric bypass—a national register-based cohort study. Obes Surg. 2013;23(8):1281–5.CrossRefPubMed Kjær MM, Nilas L. Timing of pregnancy after gastric bypass—a national register-based cohort study. Obes Surg. 2013;23(8):1281–5.CrossRefPubMed
19.
go back to reference Stentebjerg LL, Andersen LLT, Renault K, et al. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass. J Matern Fetal Neonatal Med. 2017;30(10):1182–8.CrossRefPubMed Stentebjerg LL, Andersen LLT, Renault K, et al. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass. J Matern Fetal Neonatal Med. 2017;30(10):1182–8.CrossRefPubMed
20.
go back to reference Yau PO, Parikh M, Saunders JK, et al. Pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. Surg Obes Relat Dis. 2017;13(11):1899–905.CrossRefPubMed Yau PO, Parikh M, Saunders JK, et al. Pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. Surg Obes Relat Dis. 2017;13(11):1899–905.CrossRefPubMed
21.
go back to reference González I, Rubio MA, Cordido F, et al. Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obes Surg. 2015;25(3):436–42.CrossRefPubMed González I, Rubio MA, Cordido F, et al. Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obes Surg. 2015;25(3):436–42.CrossRefPubMed
22.
go back to reference Dao T, Kuhn J, Ehmer D, et al. Pregnancy outcomes after gastric-bypass surgery. Am J Surg. 2006;192(6):762–6.CrossRefPubMed Dao T, Kuhn J, Ehmer D, et al. Pregnancy outcomes after gastric-bypass surgery. Am J Surg. 2006;192(6):762–6.CrossRefPubMed
23.
go back to reference 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(12):1517–21.CrossRefPubMed 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(12):1517–21.CrossRefPubMed
24.
go back to reference Parent B, Martopullo I, Weiss NS, et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg. 2017;152(2):1–8.CrossRefPubMed Parent B, Martopullo I, Weiss NS, et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg. 2017;152(2):1–8.CrossRefPubMed
25.
go back to reference Dalfra MG, Busetto L, Chilelli NC, et al. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med. 2012;25(9):1537–43.CrossRefPubMed Dalfra MG, Busetto L, Chilelli NC, et al. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med. 2012;25(9):1537–43.CrossRefPubMed
26.
go back to reference Chevrot A, Kayem G, Coupaye M, et al. Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol. 2016;214(5):655 e1–7.CrossRefPubMed Chevrot A, Kayem G, Coupaye M, et al. Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol. 2016;214(5):655 e1–7.CrossRefPubMed
27.
go back to reference Frame-Peterson LA, Megill RD, Carobrese S, et al. Nutrient deficiencies are common prior to bariatric surgery. Nutr Clin Pract. 2017;32(4):463–9.CrossRefPubMed Frame-Peterson LA, Megill RD, Carobrese S, et al. Nutrient deficiencies are common prior to bariatric surgery. Nutr Clin Pract. 2017;32(4):463–9.CrossRefPubMed
28.
go back to reference Gesquiere I, Foulon V, Augustijns P, et al. Micronutrient intake, from diet and supplements, and association with status markers in pre- and post-RYGB patients. Clin Nutr. 2017;36(4):1175–81.CrossRefPubMed Gesquiere I, Foulon V, Augustijns P, et al. Micronutrient intake, from diet and supplements, and association with status markers in pre- and post-RYGB patients. Clin Nutr. 2017;36(4):1175–81.CrossRefPubMed
29.
go back to reference Hue O, Marcotte J, Berrigan F, et al. Increased plasma levels of toxic pollutants accompanying weight loss induced by hypocaloric diet or by bariatric surgery. Obes Surg. 2006;16(9):1145–54.CrossRefPubMed Hue O, Marcotte J, Berrigan F, et al. Increased plasma levels of toxic pollutants accompanying weight loss induced by hypocaloric diet or by bariatric surgery. Obes Surg. 2006;16(9):1145–54.CrossRefPubMed
30.
go back to reference Jansen A, Lyche JL, Polder A, et al. Increased blood levels of persistent organic pollutants (POP) in obese individuals after weight loss-a review. Toxicol Environ Health B Crit Rev. 2017;20(1):22–37.CrossRef Jansen A, Lyche JL, Polder A, et al. Increased blood levels of persistent organic pollutants (POP) in obese individuals after weight loss-a review. Toxicol Environ Health B Crit Rev. 2017;20(1):22–37.CrossRef
31.
go back to reference Ducarme G, Parisio L, Santulli P, et al. Neonatal outcomes in pregnancies after bariatric surgery: a retrospective multi-centric cohort study in three French referral centers. J Matern Fetal Neonatal Med. 2013;26(3):275–8.CrossRefPubMed Ducarme G, Parisio L, Santulli P, et al. Neonatal outcomes in pregnancies after bariatric surgery: a retrospective multi-centric cohort study in three French referral centers. J Matern Fetal Neonatal Med. 2013;26(3):275–8.CrossRefPubMed
32.
go back to reference Norgaard LN, Gjerris AC, Kirkegaard I, et al. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study. PLoS One. 2014;9(3):e90317.CrossRefPubMedPubMedCentral Norgaard LN, Gjerris AC, Kirkegaard I, et al. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study. PLoS One. 2014;9(3):e90317.CrossRefPubMedPubMedCentral
33.
go back to reference Mahawar KK, Graham Y, Small PK. Optimum time for pregnancy after bariatric surgery. Surg Obes Relat Dis. 2016;12(5):1126–8.CrossRefPubMed Mahawar KK, Graham Y, Small PK. Optimum time for pregnancy after bariatric surgery. Surg Obes Relat Dis. 2016;12(5):1126–8.CrossRefPubMed
Metadata
Title
Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes
Authors
Cátia Rasteiro
Célia Araújo
Sara Cunha
Rita Caldas
Joana Mesquita
Adérito Seixas
Nuno Augusto
Carla Ramalho
Publication date
01-11-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3395-5

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