History Of Bariatric Surgery Has Risks and Benefits For Pregnancy

Kari Johansson, Phd Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with:
Kari Johansson, PhD

Department of Medicine Solna, Karolinska Institutet
Clinical Epidemiology
Karolinska University Hospital
Stockholm, Sweden

 

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers.

The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001). 

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Johannson: This study shows that a history of bariatric surgery [of which 98% were gastric bypass] is associated with both benefits and risks during pregnancy.  At this point we do not know whether the adverse perinatal outcomes found in our study can be prevented through increased monitoring of fetal growth and maternal nutritional status. However, until proven otherwise, we believe that pregnancies in this group of women ought to be given special care from maternal health services, such as extra ultrasound scans to monitor fetal growth, and detailed dietary advice that includes checking the intake of the necessary post-surgery supplements.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Johannson: Examples of studies that are needed:

  1. What are the mechanisms behind the increased risk of fetal growth restriction?
  2. Are the adverse fetal outcomes preventable?
  3. Do different procedures carry different risks?

Citation:
Outcomes of Pregnancy after Bariatric Surgery
Kari Johansson, Ph.D., Sven Cnattingius, M.D., Ph.D., Ingmar Näslund, M.D., Ph.D., Nathalie Roos, M.D., Ph.D., Ylva Trolle Lagerros, M.D., Ph.D., Fredrik Granath, Ph.D., Olof Stephansson, M.D., Ph.D., and Martin Neovius, Ph.D.

N Engl J Med 2015; 372:814-824
February 26, 2015

DOI: 10.1056/NEJMoa1405789
MedicalResearch.com Interview with: Kari Johansson, PhD (2015). History Of Bariatric Surgery Has Risks and Benefits For Pregnancy

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