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Moradi R, Navaee M, Zamaninour N, Setaredan A, Pazouki A, Kabir A. The Effect of Maternal Bariatric Surgery on Offspring Anthropometry: A Mixed Cohort. Obes Surg 2024:10.1007/s11695-024-07361-8. [PMID: 38877371 DOI: 10.1007/s11695-024-07361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Although bariatric surgery is associated with a decrease in obesity complications, it may affect the children's growth by a maternal nutritional deficiency. This study was conducted to assess the effect of maternal bariatric surgery on offspring anthropometry. MATERIALS AND METHODS In a mixed cohort, anthropometric status of children aged 5 years or less born to mothers with a history of bariatric surgery was compared with a control group consists of peers born to mothers with obesity but without bariatric surgery. Anthropometric indices including crude and quantile values for BMI, weight, height, and head circumference at birth and the first 5 years of life were measured. Then, the adjusted effect of maternal surgical history on anthropometric status was estimated by linear regression. RESULTS From a total of 56 children, 28 born to mothers with a history of bariatric surgery, and 28 born to mothers with obesity but without bariatric surgery. At birth, weight (2915 vs 3225 g) and BMI (11.72 vs 12.94 kg/m2) were lower in the group with maternal bariatric surgery than in the control group (P = 0.02 and P = 0.03, respectively), although after regression adjustment, there was only a significant difference between the two groups in height for age value in children less than 5 years old (B = 0.872, P-value = 0.001). CONCLUSION Bariatric surgery with decrease of weight indices at birth has a probable influence on growth and development in next years. Therefore, it is recommended further studies to identify unknown effect of types of preconception surgical procedures on childhood outcomes.
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Affiliation(s)
- Raheleh Moradi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Navaee
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Zamaninour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Setaredan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-E Rasool Hospital, Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Joly MA, Peyronnet V, Coupaye M, Ledoux S, Pourtier N, Pencole L, Mandelbrot L. Comparison of pregnancy outcomes after bariatric surgery by sleeve gastrectomy versus gastric bypass. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100309. [PMID: 38736525 PMCID: PMC11088267 DOI: 10.1016/j.eurox.2024.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/01/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
Objective Bariatric surgery has an impact on subsequent pregnancies, in particular an association between gastric bypass and small for gestational age. Knowledge is lacking on whether sleeve gastrectomy is associated with more favorable pregnancy outcomes. This study aimed to compare the impact of sleeve gastrectomy and Roux-en-Y gastric bypass on the incidence of small for gestational age (SGA), and of adverse pregnancy outcomes. Study design We conducted a retrospective study in a single reference center, including all patients with a history of sleeve or bypass who delivered between 2004 and 2021 after their first pregnancy following bariatric surgery. We compared the incidence of SGA, intrauterine growth retardation, preterm delivery and adverse maternal outcomes between patients who had sleeve versus bypass. Results Of 244 patients, 145 had a sleeve and 99 had a bypass. The proportion of SGA < 10th percentile did not differ between the two groups (38/145 (26.2 %) vs 22/99 (22.22 %), respectively, p = 0.48). Preterm birth < 37 WG was lower in the sleeve group (5/145 (3.45%) vs 12/99 (12.12 %) in the bypass group (p = 0.01), as well as NICU hospitalizations (3 (2.07%) vs 12/99 (12.12%), p < 0.01). There was no difference regarding adverse maternal outcomes such as gestational diabetes and hypertensive complications. The proportion of SGA was not lower in patients with bypass when adjusting for other risk factors (BMI, smoking, geographic origin, diabetes and hypertension) (aOR 0.70; 95%CI 0.01 - 2.85). Conclusion sleeve was associated with an incidence of SGA which was as high as after bypass, however the incidence of preterm birth was lower.
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Affiliation(s)
- Marie-Anne Joly
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, FHU PREMA, Hôpital Louis-Mourier, Colombes, France
- Université Paris Cité, Paris, France
| | - Violaine Peyronnet
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, FHU PREMA, Hôpital Louis-Mourier, Colombes, France
| | - Muriel Coupaye
- Université Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de Prise en Charge de l′Obésité (CINFO), Hôpital Louis-Mourier, Colombes, France
- Inserm UMRS 1149, Paris 75018, France
| | - Séverine Ledoux
- Université Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de Prise en Charge de l′Obésité (CINFO), Hôpital Louis-Mourier, Colombes, France
- Inserm UMRS 1149, Paris 75018, France
| | - Nicolas Pourtier
- Université Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Chirurgie Digestive, Centre Intégré Nord Francilien de Prise en Charge de l′Obésité (CINFO), Hôpital Louis-Mourier, Colombes, France
| | - Lucile Pencole
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, FHU PREMA, Hôpital Louis-Mourier, Colombes, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, FHU PREMA, Hôpital Louis-Mourier, Colombes, France
- Université Paris Cité, Paris, France
- Inserm IAME 1137, Paris, France
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Breslin TB, Dindinger RA, Andromalos L, Agunsday J. Perinatal Care for People With a History of Metabolic and Bariatric Surgery: AWHONN Practice Brief #19. Nurs Womens Health 2023; 27:e6-e8. [PMID: 37791944 DOI: 10.1016/j.nwh.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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Perinatal Care for People With a History of Metabolic and Bariatric Surgery: AWHONN Practice Brief #19. J Obstet Gynecol Neonatal Nurs 2023; 52:e8-e10. [PMID: 37791934 DOI: 10.1016/j.jogn.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
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Cornelissen LGH, Carrière L, Hack KEA. Surgical complications in pregnancy after bariatric surgery; a case series. J Gynecol Obstet Hum Reprod 2023; 52:102614. [PMID: 37270105 DOI: 10.1016/j.jogoh.2023.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Obesity is a rising world-wide problem and bariatric surgery, also in the reproductive age, is increasingly performed. Bariatric procedures are associated with surgical complications during pregnancy, such as internal herniation. CASES In this case series three cases with severe surgical complications after Roux-Y gastric bypass are described. In all three cases surgery was needed to prevent further complications. In one case subtotal bowel resection had to be performed because of extensive necrosis and intra-uterine fetal death was found. CONCLUSION Though surgical complications after Roux-Y gastric bypass are not very common, complications can be very serious and lead to severe morbidity and even mortality for mother and fetus. Because of the severity of complications, delaying bariatric surgery or considering alternative bariatric techniques with fewer (severe) complications should be considered in obese women in childbearing age.
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Affiliation(s)
- Lisa G H Cornelissen
- Gelre Ziekenhuizen, Albert Schweitzerlaan 31, Apeldoorn, DZ 7334, the Netherlands.
| | - Laura Carrière
- Gelre Ziekenhuizen, Albert Schweitzerlaan 31, Apeldoorn, DZ 7334, the Netherlands
| | - Karien E A Hack
- Gelre Ziekenhuizen, Albert Schweitzerlaan 31, Apeldoorn, DZ 7334, the Netherlands
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6
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Kistner A, Werner A, Zaigham M. Adverse perinatal outcomes after Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy: a systematic review. BMC Pregnancy Childbirth 2023; 23:557. [PMID: 37532995 PMCID: PMC10394842 DOI: 10.1186/s12884-023-05515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/13/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG). METHODS A systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time from surgery to conception, birth weight, gestational age and intrauterine fetal death. Article selection, risk of bias assessment and data extraction, were performed by two authors. The study protocol was published in its revised form in PROSPERO, registration number: CRD42021234480. RESULTS A total of 3201 records were extracted. After duplicates were removed, 3143 records were screened for inclusion. Six studies fitted the selection criteria, of which four studies were RYGB and two SG (1100 post-RYGB vs. 209 post-SG). For the included studies, higher incidence of both SGA (22.9%, 11.9%, 14.2%) and LGA (4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%) were observed. SG had a shorter surgery to conception interval as compared to RYGB. Risk of bias assessment was moderate to serious for the studies included in the review, with bias in selection of participants being the major reason. CONCLUSION Our systematic review demonstrated no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG. The rate of SGA and LGA births were higher in the SG group, but this group also had a shorter surgery to conception interval. Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes.
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Affiliation(s)
- Astrid Kistner
- Department of Obstetrics & Gynecology, Lund University and Skåne University Hospital, Malmö, 205 01, Sweden
| | - Alva Werner
- Department of Obstetrics & Gynecology, Lund University and Skåne University Hospital, Malmö, 205 01, Sweden
| | - Mehreen Zaigham
- Department of Obstetrics & Gynecology, Lund University and Skåne University Hospital, Malmö, 205 01, Sweden.
- Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
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7
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Yu Y, Groth SW. Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review. Arch Gynecol Obstet 2023; 307:343-378. [PMID: 35332360 DOI: 10.1007/s00404-022-06480-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Bariatric surgery increases the risk of lower birth weight, small-for-gestational-age (SGA) infants, and preterm birth in a subsequent pregnancy. However, the factors that contribute to these adverse birth outcomes are unclear. This review aimed to collate available information about risk factors of lower birth weight, SGA, and preterm birth following bariatric surgery. METHODS A literature search was conducted using five databases (PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library) to obtain relevant studies. RESULTS A total number of 85 studies were included. Studies generally excluded surgery-to-conception interval, pregnancy complications, cigarette use, and maternal age as influencing factors of birth weight, SGA, or preterm birth. In contrast, most studies found that malabsorptive procedures, lower gestational weight gain, lower glucose levels, abdominal pain, and insufficient prenatal care were associated with an elevated risk of adverse birth outcomes. Findings were mixed regarding the effects of surgery-to-conception weight loss, pre-pregnancy body mass index, micronutrient deficiency, and lipid levels on birth outcomes. The examination of maternal microbiome profiles, placental function, alcohol use, and exercise was limited to one study; therefore, no conclusions could be made. CONCLUSION This review identified factors that appear to be associated (e.g., surgery type) or not associated (e.g., surgery-to-conception interval) with birth outcomes following bariatric surgery. The mixed findings and the limited number of studies on several variables (e.g., micronutrients, exercise) highlight the need for further investigation. Additionally, future studies may benefit from exploring interactions among risk factors and expanding to assess additional exposures such as maternal mental health.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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8
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Cordero L, Stenger MR, Landon MB, Needleman BJ, Noria S, Nankervis CA. Breastfeeding following bariatric surgery among obese women with and without diabetes mellitus. J Neonatal Perinatal Med 2023; 16:475-483. [PMID: 37718858 DOI: 10.3233/npm-221085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Information on exclusive breastfeeding (BF) and BF initiation following bariatric surgery (BS) among obese women with diabetes mellitus (DM) and without DM (non-DM) is limited. METHODS Retrospective cohort study. Obesity was defined by BMI (kg/m2) as grade 1 (30-34.9), grade 2 (35-39.9) or grade 3 (≥40). The 65 women in the DM group (40 women with gestational, 19 with Type 2 and 6 with Type 1) was similar to 84 with non-DM in BS type: Roux-en-Y (51 vs 55%), sleeve gastrectomy (32 vs 35%), laparoscopic gastric banding (17 vs 7%) and gastro-duodenal anastomosis (0 vs 4%). RESULTS Women with DM were older (35 vs 33y), of advanced age (54 vs 27%), with higher prevalence of grade 3 obesity (66 vs 46%), chronic hypertension (31 vs 10%), delivery of late-preterm infants (23 vs 10%) and neonatal hypoglycemia (25 vs 12%). Although infant feeding intention was similar: BF (66 vs 79%), partial BF (9 vs 7%) or formula (25 vs 14%), at discharge women with DM had lower exclusive BF (29 vs 41%) and BF initiation rates (68 vs 76%) than those with non-DM. Women with grade 3 obesity (52% were DM) differed from those with grades 1-2 (34% were DM) in exclusive BF (27 vs 52%), and BF initiation rates (66 vs 86%). CONCLUSION After BS, women with DM, especially those with grade 3 obesity, had higher rates of chronic hypertension and preeclampsia and lower rates of exclusive BF and BF initiation than those who had DM but had less severe obesity.
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Affiliation(s)
- L Cordero
- Department of Pediatrics, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M R Stenger
- Department of Pediatrics, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M B Landon
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - B J Needleman
- Department of Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Noria
- Department of Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C A Nankervis
- Department of Pediatrics, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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9
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Beiglböck H, Mörth E, Reichardt B, Stamm T, Itariu B, Harreiter J, Eichelter J, Prager G, Kautzky-Willer A, Wolf P, Krebs M. The Timing of Pregnancies After Bariatric Surgery has No Impact on Children's Health-a Nationwide Population-based Registry Analysis. Obes Surg 2023; 33:149-155. [PMID: 36344726 PMCID: PMC9834372 DOI: 10.1007/s11695-022-06346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Bariatric surgery has a favorable effect on fertility in women. However, due to a lack of data regarding children's outcomes, the ideal time for conception following bariatric surgery is unknown. Current guidelines advise avoiding pregnancy during the initial weight loss phase (12-24 months after surgery) as there may be potential risks to offspring. Thus, we aimed to analyze health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied. MATERIALS AND METHODS A nationwide registry belonging to the Austrian health insurance funds and containing health-related data claims was searched. Data for all women who had bariatric surgery in Austria between 01/2010 and 12/2018 were analyzed. A total of 1057 women gave birth to 1369 children. The offspring's data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalized. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months. RESULTS Overall, 421 deliveries (31%) were observed in the first 2 years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalization and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval. CONCLUSION Pregnancies in the first 24 months after bariatric surgery were common. Importantly, the surgery-to-delivery interval had no significant impact on the health outcome of the children.
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Affiliation(s)
- Hannes Beiglböck
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Eric Mörth
- grid.7914.b0000 0004 1936 7443Department of Informatics, University of Bergen, 5008 Bergen, Norway ,grid.412008.f0000 0000 9753 1393Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, 5021 Bergen, Norway
| | | | - Tanja Stamm
- grid.22937.3d0000 0000 9259 8492Center for Medical Statistics, Informatics and Intelligent Systems, Institute for Outcomes Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria ,grid.491977.5Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Bianca Itariu
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jürgen Harreiter
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jakob Eichelter
- grid.22937.3d0000 0000 9259 8492Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gerhard Prager
- grid.22937.3d0000 0000 9259 8492Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexandra Kautzky-Willer
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Peter Wolf
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Krebs
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Savastano G, Caruso G, Pompeo D, Lobozzo B, Perrone G, Pecorini F, Palaia I, Muzii L, Galoppi P, Brunelli R. Pregnancy and post-partum outcomes of obese women after bariatric surgery: A case-control study. Eur J Obstet Gynecol Reprod Biol 2022; 272:43-47. [PMID: 35279640 DOI: 10.1016/j.ejogrb.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/13/2022] [Accepted: 03/04/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Bariatric surgery (BS) is known to reduce several obesity-related complications during pregnancy, but there is concern that it may increase the risk of maternal-fetal morbidity because of the malabsorption. This study aimed to investigate the impact of restrictive BS on several pregnancy outcomes in comparison with different grades of obesity. MATERIALS AND METHODS A single-center retrospective case-control study. All primiparous singleton pregnant women who underwent BS between the previous 1-5 years or with body mass index (BMI) ≥ 30 kg/m2 delivering in our center were included. Obstetric and perinatal outcomes were analyzed and compared between the two groups. RESULTS Overall, 90 women were included: 30 underwent BS and 60 were obese. The mean pre-pregnancy BMI was 31.0 ± 4.2 kg/m2 in the BS group and 38.1 ± 4.3 kg/m2 in the control group (p < 0.001). The obese group experienced higher rate of fetal macrosomia (25% vs 6.7%; p = 0.049), gestational hypertension (23.3% vs 3.3%; p = 0.04), preeclampsia (23.3% vs 0%; p = 0.04), gestational diabetes (33.3% vs 6.7%; p = 0.01), and cesarean section (68.3% vs 20%; p < 0.0001). The BS group showed higher frequency of small for gestational age (SGA) (46.7% vs 18.3%; p = 0.006), late preterm delivery (PTD) (33.3% vs 10%; p = 0.009), cholestasis (13.3% vs 1.7%; p = 0.049). Breastfeeding ≥ 6 months was higher among BS mothers (36.7% vs 11.7%; p = 0.007). CONCLUSIONS Our findings support the positive impact of BS on several obstetric outcomes, at the expense of a higher frequency of SGA and PTD. BS mothers more frequently achieved the recommended goal of breastfeeding for 6 months compared to obese women.
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Affiliation(s)
- Giovanna Savastano
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy.
| | - Damiana Pompeo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Benedetta Lobozzo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Giuseppina Perrone
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Francesco Pecorini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Paola Galoppi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
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11
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Hefetz L, Ben-Haroush Schyr R, Bergel M, Arad Y, Kleiman D, Israeli H, Samuel I, Azulai S, Haran A, Levy Y, Sender D, Rottenstreich A, Ben-Zvi D. Maternal antagonism of Glp1 reverses the adverse outcomes of sleeve gastrectomy on mouse offspring. JCI Insight 2022; 7:156424. [PMID: 35393955 PMCID: PMC9057621 DOI: 10.1172/jci.insight.156424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/25/2022] [Indexed: 12/30/2022] Open
Abstract
Mothers that underwent bariatric surgery are at higher risk for delivering a small-for-gestational age (SGA) infant. This phenomenon is attributed to malabsorption and rapid weight loss following surgery. We compared pregnancy outcomes in lean mice that underwent sham surgery or sleeve gastrectomy (SG). SG led to a reduction in glucose levels and an increase in postprandial levels of glucagon-like peptide 1 (Glp1) without affecting mice weight during pregnancy. Pups of SG-operated mice (SG pups) were born SGA. The placenta and pancreas of the pups were not affected by SG, although a high-fat diet caused hepatic steatosis and glucose intolerance in male SG pups. Treatment with a Glp1 receptor antagonist during pregnancy normalized the birth weight of SG pups and diminished the adverse response to a high-fat diet without affecting glucose levels of pregnant mice. The antagonist did not affect the birth weight of pups of sham-operated mice. Our findings link elevated Glp1 signaling, rather than weight loss, to the increased prevalence of SGA births following bariatric surgery with metabolic consequences for the offspring. The long-term effects of bariatric surgery on the metabolic health of offspring of patients require further investigation.
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Affiliation(s)
- Liron Hefetz
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Military Medicine and Tzameret, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Medical Corps, Israel Defense Forces, Israel
| | - Rachel Ben-Haroush Schyr
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Michael Bergel
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yhara Arad
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Military Medicine and Tzameret, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Medical Corps, Israel Defense Forces, Israel
| | - Doron Kleiman
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Hadar Israeli
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Itia Samuel
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Shira Azulai
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Arnon Haran
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yovel Levy
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Dana Sender
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology and.,Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Danny Ben-Zvi
- Department of Developmental Biology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Pregnancy Complications in Women with Weight Loss Surgery Compared to a Non-Surgical Population of Women with Obesity. Obes Surg 2022; 32:991-997. [PMID: 35041122 DOI: 10.1007/s11695-022-05895-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of this study was to assess the effect of WLS on pregnancy and delivery complications in women who had WLS compared to women with obesity who did not undergo WLS. METHODS We used the National Inpatient Sample data from 2012 to 2017, with a study population of women between the ages of 20 and 44 who had a maternal admission code in the NIS data (n = 663,795). Weighted logistic regression models were fitted and the models were stratified by race. Covariates included age, race, primary payer, previous cesarean delivery, physical health comorbidities, and depression. RESULTS There were decreased odds of gestational diabetes in women of all races (aORall = 0.47, 95% CIall = 0.44-0.49). There were decreased odds for gestational hypertension in women of all races (aORall = 0.55, 95% CIall = 0.51-0.59). Compared to women who did not have WLS, there were lower odds of cesarean delivery among women with a history of WLS (aORall = 0.62, 95% CIall = 0.60-0.65), which was true for White women, Black women, and Latinas with a history of WLS (aORWhite = 0.57, 95% CIWhite = 0.53-0.60; aORBlack = 0.67, 95% CIBlack = 0.61-0.74; aORLatina = 0.71, 95% CILatina = 0.64-0.78). CONCLUSIONS Overall, women with history of WLS had lower odds of most of the pregnancy outcomes (gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia, and cesarean delivery) with results mediated by race.
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Reproductive outcomes after bariatric surgery in women. Wien Klin Wochenschr 2021; 134:56-62. [PMID: 34878586 PMCID: PMC8813708 DOI: 10.1007/s00508-021-01986-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 01/11/2023]
Abstract
The presence of obesity may significantly influence female fertility through various mechanisms. Impairment of the hypothalamic-pituitary-ovarian axis in obese women may induce anovulation and infertility. Obesity may have an effect on women’s spontaneous and assisted conception rates, increased miscarriage rates, premature labor, stillbirth and perinatal risks, and menstrual irregularity. It has been suggested that weight loss improves reproductive outcomes due to fertility amelioration and an improvement in menstrual irregularity and ovulation. It is still not known which weight reduction procedures (changes in lifestyle, pharmacological management or bariatric intervention) result in optimal outcome on infertility. Currently, bariatric surgery is defined as the best available method for the management of obesity and its associated diseases. We have analyzed literature facts about effects of bariatric surgery on the function of the hypothalamic-pituitary-ovarian axis, polycystic ovary syndrome (PCOS), anti-Mullerian hormone (AMH) and sexual dysfunction in obesity and pregnancy in obesity. Immediate positive effects of bariatric surgery are evident at the moment, while for long-term outcomes more prolonged follow-up investigations should be done.
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