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Is Restrictive Bariatric Surgery Good Option in Improving Pregnancy Outcome in Obese Women?

Hend S Saleh, Hala E Mowafy, Khaled Fathy Helal and Walid A Abdelsalam

Maternal obesity is a major cause of obstetric morbidity and mortality. Strong evidence links weight loss with improved fertility outcomes and reduced gestational complications in subsequent pregnancies.Bariatric Surgical procedures became widely available and facilitate weight loss .The procedure is effective in preventing the complications surrounding reproduction and pregnancy often seen in the obese woman. Restrictive procedure is one of bariatric surgery which is safe and effective treatment of obesity.

Aim of study: This study is done to evaluate the pregnancy outcome following restrictive bariatric surgery; the Laparoscopic Adjustable Gastric Banding (LAGB) and vertical-banded gastroplasty (VBG).

Methods: This prospective cohort study was carried out in Obstetric department of Zagazig University Hospitals between June 2011 and July 2014. The study enrolled 450 obese pregnant women whose pre-pregnancy mean body weight and BMI at the onset of pregnancy were 98 kg and 33.9 respectively. 50 women underwent restrictive bariatric surgery either by laparoscopic adjustable gastric banding (LAGB) or, vertical-banded gastroplasty (VBG) as (study group) and 400 women who were obese without underwent surgery (Control group). The mean interval from surgery to conception averaged 18.8 with standard deviation 10.2 months and those women lost a mean of 29 kg body weight before becoming pregnant. All were recruited from antenatal outpatient clinic. The exclusion criteria in both groups were; any medical disorders like hypertension, diabetes mellitus and previous caesarean section or uterine scar. We compared pregnancy complications, weight change during pregnancy, nutritional deficiencies fetal birth weight and outcome, and mode of delivery between both groups.

Results: The percentage of pregnancy-induced hypertension in post-bariatric surgery women (case group) less than in the control group (8.5%) versus 20%; P=0.001), rates of gestational diabetes mellitus (6.9% versus 12.8%; P=0.007). Rates of preeclampsia and eclampsia was (2.1% versus 7.5%, P=0.005). Nutritional deficiencies for mother post-bariatric surgery were more than those without surgery. Neonatal outcomes were similar or better after surgery compared with obese women. The rate of miscarriage, premature delivery and congenital anomalies percentages did not seem to significantly differ in pregnancies after bariatric surgery compared to control groups. The proportion of infants being small for gestational age was 6.2% versus 5.6% with no statistically significant differences but the proportion of large for gestational age infants was 4.1% versus 9.6% with significant differences p value 0.003. Cesarean deliveries were significantly more frequent in control women than in study cases (24.8% vs. 12.7%) with p value 0.001. Also, percentage of vaginal delivery in (case group) was significant higher than in (control group) but no significant differences in percentage of Instrumental deliveries.

Conclusion: Restrictive Bariatric surgery appears to be safe procedure, well tolerated during pregnancy and to have positive effects on pregnancy outcome when compared to pregnancies of obese women without surgery.