A comparison of complications of pregnancy and delivery in morbidly obese and non-obese women

The Impact of Pregnancy on Outcomes After Bariatric Surgery

BACKGROUND

Bariatric surgery is performed mostly on obese women of reproductive age. Many studies have analyzed pregnancy outcomes after bariatric surgery, but only a small number have studied the impact of pregnancy on the postoperative outcomes.

PURPOSE

To study the effect of pregnancy on outcomes after bariatric surgery in women of childbearing age.

METHODS

From January 2010 to October 2017, a retrospective study of a prospectively maintained database was conducted at the University Hospital of Geneva (HUG), where 287 women between the ages of 18 and 45 years had undergone Roux-en-Y gastric bypass (RYGB). A comparison of the results during a 5-year follow-up was performed between women who became pregnant after their bariatric surgery (pregnancy group, n = 40) and postoperative non-pregnant women (non-pregnancy group, n = 247). The two groups were compared for weight loss, complications, and nutritional deficiencies.

RESULTS

The pregnancy group was significantly younger (29.2 ± 5.5 vs. 36.4± 6.3 years, p < 0.001) and heavier (124.0 ± 18.0 kg vs. 114.7 ± 17.1, p < 0.001) compared with the non-pregnancy group at the time of surgery. The percentage of excess BMI loss (%EBMI loss) was similar in both groups during the 5-year follow-up. Complications after RYGB and nutritional deficiencies were nearly identical in the two groups. The interval of time between bariatric surgery and first pregnancy was a median of 20.8 months. Out of 40 first pregnancies, 28 women completed pregnancy successfully with live birth.

CONCLUSION

Pregnancy after bariatric surgery is safe and does not adversely affect outcomes after RYGB.

Maternal and perinatal outcomes after bariatric surgery: a case control study

OBJECTIVE

To compare the results of maternal and perinatal pregnancies of obese women after bariatric surgery.

METHODS

A retrospective cross-sectional study was carried out on 63 women who had undergone bariatric surgery and 73 obese women (control). Demographic data, the characteristics of the bariatric surgery, and the maternal and perinatal results were evaluated. The Student's t-test and chi-square test (χ2) were used to compare the groups. The gestational complications of the prevalence of gestational diabetes mellitus, anemia, and preeclampsia were analyzed using simple and multivariate logistical regression and odd ratios (OD) with their respective confidence intervals (CI) of 95%.

RESULTS

The average body mass index (BMI) at the 1st prenatal appointment of the control group was 34.6±3.3 kg/m2 and that of the post-surgical group was 26.5±4.2 kg/m2. The Roux-en-Y Gastric Bypass was used in 100% of cases; no complications were observed during or after the surgeries. The average weight loss in patients with a prior bariatric surgery was statistically significant (P=0.000). The average weight at birth of the control group was significantly higher than in the post-bariatric surgery group (P=0.017). The women who had a prior bariatric surgery had a higher chance of anemia (OR=3.5; CI 95%: 1.5-8.3) and a reduced chance of macrosomia (OR=0.2; CI 95%:0.1-0.5), and prematurity (OR=0.3; CI 95%:0.1-0.7).

CONCLUSION

Those women who had been submitted to bariatric surgery presented better maternal and perinatal results when compared to obese women.

Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia - a pilot evaluation

Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life.

Objective: Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data.

Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences.

Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country-specific data on the incidence of macrosomic births and health outcomes. In addition, it would be of interest to further explore the long-term health economic consequences of macrosomia and related risk factors.

Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis

OBJECTIVE

To determine a precise estimate for the contribution of maternal obesity to macrosomia.

DATA SOURCES

The search strategy included database searches in 2011 of PubMed, Medline (In-Process & Other Non-Indexed Citations and Ovid Medline, 1950-2011), and EMBASE Classic + EMBASE. Appropriate search terms were used for each database. Reference lists of retrieved articles and review articles were cross-referenced.

METHODS OF STUDY SELECTION

All studies that examined the relationship between maternal obesity (BMI ≥30 kg/m(2)) (pregravid or at 1st prenatal visit) and fetal macrosomia (birth weight ≥4000 g, ≥4500 g, or ≥90th percentile) were considered for inclusion.

TABULATION, INTEGRATION, AND RESULTS

Data regarding the outcomes of interest and study quality were independently extracted by two reviewers. Results from the meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birth weight ≥ 4000 g (OR 2.17, 95% CI 1.92, 2.45), birth weight ≥4500 g (OR 2.77,95% CI 2.22, 3.45), and birth weight ≥90% ile for gestational age (OR 2.42, 95% CI 2.16, 2.72).

CONCLUSION

Maternal obesity appears to play a significant role in the development of fetal overgrowth. There is a critical need for effective personal and public health initiatives designed to decrease prepregnancy weight and optimize gestational weight gain.

Determinants of overweight and obesity among Bangladeshi diabetic women of reproductive age

BACKGROUND

Several reproductive disorders with overweight and obesity are now known to be associated with insulin resistance. The study was aimed to assess the proportion and determinants of overweight and obesity among diabetic women of reproductive age.

METHODS

This cross-sectional analytic study was conducted among 888 diabetic women of reproductive age attending the out-patient department (OPD) of the central hospital of the Diabetic Association. Body Mass Index (BMI) was used to assess the general obesity. Waist Circumference (WC), Waist-Hip Ratio (WHR) and Waist-Height Ratio (WHtR) were used to assess central obesity.

RESULTS

The overall prevalence of overweight was 22% (95% CI 19-24) and that of obesity was 48% (95% CI 45-51). Prevalence of central obesity by waist circumference was 77%, by waist-hip ratio was 99.9% and by waist-height ratio was 89%. Overweight and obesity were higher in the age group of 45-49 years (49%) and 35-44 years (24%) respectively. On Pearson's correlation analysis, BMI and WC were significantly correlated with age (r = 0.135, p = 0.001; r = 0.162, p = 0.001) and income (r = 0.151, p = 0.001; r = 0.087, p = 0.009) respectively. WHR was also correlated with income (r = 0.094, p = 0.005). Moreover, WHtR was significantly correlated with age (r =  0.139, p = 0.001), income (r = 0.069, p = 0.04) and duration of diabetes (r = 0.073, p = 0.03).On binary logistic regression analysis, BMI was significantly associated with age, income and management of diabetes by Oral Hypoglycemic Agent (OHA) (p < 0.05). WC was significantly associated with age, income and management of diabetes by OHA and insulin (p < 0.05). Where, WHR was significantly associated only with duration of diabetes (p < 0.05). WHtR was significantly associated with age (p < 0.05), management of diabetes by OHA (p < 0.05) and insulin (p < 0.05) in this analysis.

CONCLUSIONS

A high prevalence of both overweight and obesity exists in diabetic women of reproductive age in Bangladesh and it seems to be associated with increasing age, income, duration of diabetes, and use of oral hypoglycemic agents.

Pregnancy after laparoscopic bariatric surgery: comparative study of adjustable gastric banding and Roux-en-Y gastric bypass

BACKGROUND

Approximately 80% of patients undergoing bariatric surgery are women, and about one half of these are of reproductive age. The purpose of the present study was to compare laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in a series of morbidly obese women with respect to maternal and neonatal outcomes at a university hospital in France.

METHODS

From January 2004 to December 2008, the data from women who had undergone LAGB or LRYGB at our center and were pregnant were collected, including age, parity, gravidity, weight, body mass index (BMI) before surgery and at scheduled intervals after surgery (1, 3, 6, 12, and 18 mo and yearly thereafter), interval from surgery to conception, weight and BMI at conception, weight and weight gain during pregnancy, weight and BMI at 2 weeks after pregnancy, complications during pregnancy, gestational age, method of delivery, fetal birth weight, and fetal outcome.

RESULTS

There were 42 pregnancies in 36 women, 22 in women who had undergone LAGB and 20 who had undergone LRYGB. The LAGB and LRYGB groups were comparable for all analyzed variables, except that the preoperative weight and BMI were greater in the LRYGB group. No differences in weight or BMI were found at conception or after pregnancy. No difference was found between the 2 groups in terms of obstetric complications or neonatal outcomes. A high frequency of cesarean deliveries was necessary in both groups.

CONCLUSIONS

The results of the present study have shown that no significant difference exists in the obstetric and birth outcomes between women who have undergone LRYGB and those who have undergone LAGB.

Pregnancy after bariatric surgery

The incidence of obesity is increasing rapidly, and it affects a greater proportion of women than men. Unfortunately, obesity has a negative impact on women's reproductive health, including increased adverse perinatal outcomes. Weight loss surgery, also known as bariatric surgery, is performed in many hospitals, and can allow for significant weight loss and improvement in medical comorbidities such as diabetes and hypertension. A woman who becomes pregnant after bariatric surgery usually has an uncomplicated pregnancy but requires special attention to some complications that can occur after these procedures. This article reviews the perinatal outcomes and provides recommendations for care regarding the unique issues that arise during a pregnancy after bariatric surgery.

Maternal obesity and markers of inflammation in pregnancy

OBJECTIVES

To evaluate whether obesity is associated with changes in pro-inflammatory and immunomodulatory cytokines in pregnancy.

METHODS

We performed a cross-sectional study using maternal serum from the early second trimester to examine biomarkers associated with inflammation in relation to maternal body mass index (n=80 total).

RESULTS

Leptin and high sensitivity C-reactive protein were significantly different between groups and increased with increasing body mass index. MCP-1 was significantly increased in the morbidly obese mothers. Interleukin-2 exhibited a U-shaped relationship with body mass index; transforming growth factor-beta1 demonstrated a nonsignificant negative trend with body mass index; and the levels of hepatocyte growth factor and tumor necrosis factor-alpha did not differ appreciably between groups.

CONCLUSIONS

Maternal obesity in pregnancy is associated with changes in cytokines, protein hormones and acute phase proteins in the second trimester, with an increase in MCP-1 in the morbid obesity category, and an increase in Leptin and hsCRP with increasing BMI category.

The effects of obesity and weight gain in young women on obstetric outcomes

We investigated body mass index (BMI) and weight gain among pregnant women (ages 14 to 25) and assessed the relationship of BMI and weight gain on birth outcomes. We performed a secondary analysis of 841 women enrolled in a randomized controlled trial receiving prenatal care in two university-affiliated clinics. Almost half the patients were overweight or obese. An average of 32.3 +/- 23.6 pounds was gained in pregnancy with only 25.3% gaining the recommended weight and over half overgaining. Weight gain had a significant relationship to birth weight. Multivariate analysis showed that prepregnancy BMI but not weight gain was a significant predictor of cesarean delivery (odds ratio [OR] 1.91, confidence interval [CI] 1.24 to 2.69, P < 0.0001). When large-for-gestational-age infants were removed from the analysis, there was still a significant effect of BMI on cesarean delivery (OR 1.76, CI 1.17 to 2.66, P = 0.007) but not of weight gain (OR 1.45, CI 0.94 to 2.17, P = 0.093). Prepregnancy BMI is a more significant predictor of cesarean delivery than pregnancy weight gain in young women.

Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis

The objective of this study is to assess and quantify the risk for gestational diabetes mellitus (GDM) according to prepregnancy maternal body mass index (BMI). The design is a systematic review of observational studies published in the last 30 years. Four electronic databases were searched for publications (1977-2007). BMI was elected as the only measure of obesity, and all diagnostic criteria for GDM were accepted. Studies with selective screening for GDM were excluded. There were no language restrictions. The methodological quality of primary studies was assessed. Some 1745 citations were screened, and 70 studies (two unpublished) involving 671 945 women were included (59 cohorts and 11 case-controls). Most studies were of high or medium quality. Compared with women with a normal BMI, the unadjusted pooled odds ratio (OR) of an underweight woman developing GDM was 0.75 (95% confidence interval [CI] 0.69 to 0.82). The OR for overweight, moderately obese and morbidly obese women were 1.97 (95% CI 1.77 to 2.19), 3.01 (95% CI 2.34 to 3.87) and 5.55 (95% CI 4.27 to 7.21) respectively. For every 1 kg m(-2) increase in BMI, the prevalence of GDM increased by 0.92% (95% CI 0.73 to 1.10). The risk of GDM is positively associated with prepregnancy BMI. This information is important when counselling women planning a pregnancy.