Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes?

Pregnancy after bariatric surgeries; best time, gestational, and neonatal outcomes

Background

Many studies and organizations described bases of pregnancy timing after bariatric surgeries, but there is still a need for uniform scientific evidence for accurate timing.

We aimed to assess pregnancy outcomes and neonatal findings by timing of surgery to pregnancy to compare adverse perinatal outcomes among women who underwent bariatric surgery prior to pregnancy with those who had not.

Patients and methods

We included 200 pregnant females who previously performed different bariatric surgeries. All pregnant females were divided into three groups: early group of patients who were conceived ≤ 12 months from bariatric surgery included 50 patients (25.0%), middle group of patients who were conceived from 12 to 24 months from bariatric surgery included 50 patients (25.0%) and late group of patients who were conceived > 24 months from bariatric surgery included 100 patients (50.0%).

Results

There is a more liability to preterm deliveries in the early group in comparison with the middle and late group (P = 0.064). Gestational weight gain in the early group was lower than the middle and the late group (P = 0.002). Females in the early group have a more liability to inadequate gestational weight gain in comparison with in the middle and late group P < 0.001).

Neonatal birth weight in the early group was significantly lower than the middle and late group P < 0.001).

Conclusion

We supported recommendations of postponing pregnancy for more than 12 months after performing bariatric surgery which allowed stabilization of maternal weight, allowing adequate gestational weight gain, better fetal and maternal health later on.

Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review

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.

The Timing of Pregnancies After Bariatric Surgery has No Impact on Children's Health-a Nationwide Population-based Registry Analysis

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.

Pregnancy After Sleeve Gastrectomy: Time Matters?

PURPOSE

Obesity has an especial implication for women of childbearing age because of a higher risk of adverse outcomes during pregnancy and labor. This report aimed to analyze complications of pregnancy after sleeve gastrectomy (SG) concerning the time after surgery.

METHODS

A retrospective descriptive-analytical study was conducted including women of childbearing age who underwent sleeve gastrectomy (SG) from 2006 to 2017. Patients were divided into two groups regarding the time elapsed from SG to pregnancy: less than and greater than one year (group A /group B, respectively).

RESULTS

During the studied time, 51 pregnancies with complete clinical records were found. The mean weight and gestational age (GA) of the newborn (NB) were normal. The mean time from surgery to pregnancy was 30.4 ± 21 months. Patients from Group A and B presented 28.6% and 16.7% respectively of preterm NB (p = 0.5). Group A registered no low birth weight (LBW) babies (3.0 ± 0.4 kg) with a GA of 37.2 ± 2.1 weeks, while in Group B, 8.6% of NB were at LBW 2.1 ± 0.1 kg and GA of 33.3 ± 3.8 weeks (p = NS).

CONCLUSION

After SG, no differences in terms of maternal and neonatal complications were found concerning the time between surgery and pregnancy.

Preconceptional maternal weight loss and hypertensive disorders in pregnancy: a systematic review and meta-analysis

BACKGROUND

Hypertensive disorders of pregnancy (HDP), including pregnancy-induced hypertension (PIH), Preeclampsia (PE), Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) and chronic hypertension, are leading causes of maternal and perinatal morbidity and mortality. Although the pathophysiology of HDP is complex, preconceptional weight reduction in obese women might reduce these complications. We conducted a systematic review and meta-analysis to investigate the effectiveness of preconceptional weight loss by lifestyle intervention or bariatric surgery in overweight and obese women and the reduction of the risk of HDP.

METHODS AND RESULTS

Databases are searched until September 2019 resulting in 2547 articles: 110 full-text analysis and 29 detailed analysis. Reduced risks were shown for HDP in seven articles (n = 4381) of weight loss after lifestyle intervention or bariatric surgery (OR range 0.10-0.64), for PIH in four articles (n = 46,976) (OR range 0.14-0.79), and for PE in seven articles (n = 169,734) (OR range 0.14-0.84). The stratified analysis of weight loss after lifestyle intervention and bariatric surgery shows comparable results. The meta-analysis of 20 studies of the effectiveness of lifestyle intervention and bariatric surgery revealed reduced risks of HDP (OR 0.45 (95% CI 0.32-0.63)), PIH (OR 0.61 (95%CI 0.44-0.85)) and PE (OR 0.67 (95%CI 0.51-0.88)).

CONCLUSIONS

Preconceptional weight loss after lifestyle intervention or bariatric surgery is effective in reducing risks of HDP, PIH and PE, and emphasizes the need to optimize weight in overweight and obese women with a child wish. More research is recommended to investigate short-term and long-term beneficial and harmful side-effects of these interventions on maternal and offspring health.

Impact of Bariatric surgery on EmbrYONic, fetal and placental Development (BEYOND): protocol for a prospective cohort study embedded in the Rotterdam periconceptional cohort

INTRODUCTION

The worldwide obesity epidemic has resulted in a rise of bariatric surgery in women of reproductive age, which can lead to 'iatrogenic undernutrition'. Long-lasting undernutrition can affect maternal health, pregnancy outcomes and offspring. We hypothesise that embryonic and placental growth are impaired in pregnancies after bariatric surgery due to the changed nutritional and microbiome dynamics. Therefore, our aim is to conduct the Bariatrics and EmbrYONic Development (BEYOND) study to investigate parameters of maternal nutritional and health status after bariatric surgery, both periconceptionally and during pregnancy, particularly concentrating on embryonic and fetal growth trajectories as well as placental development.

METHODS AND ANALYSIS

We designed a single-centre prospective, observational cohort, which investigates the iatrogenic nutritional and health status of women after bariatric surgery, periconceptionally and during pregnancy. The BEYOND study is embedded in the Rotterdam Periconceptional Cohort, a tertiary hospital-based birth cohort study. Eligible participants are women planning pregnancy or <12+0 weeks pregnant, ≥18 and ≤45 years of age, who have undergone bariatric surgery (cases) or without prior bariatric surgery (controls) and their male partners. Medical charts will be reviewed and questionnaires regarding general health, lifestyle and food intake will be collected. Moreover, we will perform serial three-dimensional ultrasounds to assess embryonic growth and placental development and two-dimensional ultrasounds for fetal growth assessment. The microbiome, including the virome, and blood samples will be sampled during the preconception period and in each trimester. Multivariable linear mixed model analyses will be used to assess the associations between bariatric surgery and pregnancy outcomes.

ETHICS AND DISSEMINATION

This proposal was approved by the Medical Ethics Committee from the Erasmus MC, Rotterdam, The Netherlands. Study results will be submitted for publication in high-impact journals, presented at scientific conferences, implemented into guidelines and communicated through the Erasmus MC and collaborating partners.

TRIAL REGISTRATION NUMBER

NL8217 (www.trialregister.nl).

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

BACKGROUND

Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically.

OBJECTIVE AND RATIONALE

The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations.

SEARCH METHODS

Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. Abstracts, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies.

OUTCOMES

A total of 51 articles were analysed. The mean quality score was 5 (range 2-8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) -0.24, 95% confidence interval (CI) -0.42, -0.05) and menstrual cycle irregularities (RD -0.24, 95% CI -0.34, -0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI -0.09, 0.10) and congenital malformations (RD 0.01, 95% CI -0.02, 0.03).

WIDER IMPLICATIONS

The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.

A Matter of Timing-Pregnancy After Bariatric Surgery

PURPOSE

Current guidelines recommend to avoid pregnancy for 12-24 months after bariatric surgery because of active weight loss and an increased risk of nutritional deficiencies. However, high-quality evidence is lacking, and only a few studies included data on gestational weight gain. We therefore evaluated pregnancy and neonatal outcomes by both surgery-to-conception interval and gestational weight gain.

MATERIALS AND METHODS

A multicenter retrospective analysis of 196 singleton pregnancies following Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was conducted. Pregnancies were divided into the early group (≤ 12 months), the middle group (12-24 months), and the late group (> 24 months) according to the surgery-to-conception interval. Gestational weight gain was classified as inadequate, adequate, or excessive according to the National Academy of Medicine recommendations.

RESULTS

Pregnancy in the early group (23.5%) was associated with lower gestational age at delivery (267.1 ± 19.9 days vs 272.7 ± 9.2 and 273.1 ± 13.5 days, P = 0.029), lower gestational weight gain (- 0.9 ± 11.0 kg vs + 10.2 ± 5.6 and + 10.0 ± 6.4 kg, P < 0.001), and lower neonatal birth weight (2979 ± 470 g vs 3161 ± 481 and 3211 ± 465 g, P = 0.008) than pregnancy in the middle and late group. Inadequate gestational weight gain (40.6%) was associated with lower gestational age at delivery (266.5 ± 20.2 days vs 273.8 ± 8.4 days, P = 0.002) and lower neonatal birth weight (3061 ± 511 g vs 3217 ± 479 g, P = 0.053) compared to adequate weight gain. Preterm births were also more frequently observed in this group (15.9% vs 6.0%, P = 0.037).

CONCLUSION

Our findings support the recommendation to avoid pregnancy for 12 months after bariatric surgery. Specific attention is needed on achieving adequate gestational weight gain.

Laparoscopic sleeve gastrectomy and pregnancy outcomes: A systematic review

Obesity is a chronic disease that presents a significant prevalence among women within childbearing age. Laparoscopic sleeve gastrectomy (LSG) is a widely used method for the treatment of obesity. Several studies have examined this operation's impact on pregnancy outcomes with contradictory results. The aim of this systematic review was to examine the maternal and neonatal outcomes following LSG. The electronic databases of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus as well as grey literature from inception to December 2019 were systematically reviewed. Search strategy included the terms: "sleeve" "gastrectomy" and "pregnancy". Eligibility criteria were randomized control trials, cohort studies and case series that reported on women with LSG prior to conception and maternal and neonatal outcomes. A total of 406 distinct articles were identified with nine studies included in the systematic review. A cumulative statistical analysis reported a preoperative BMI of 43.6 ± 5.0 kg/m2 while BMI at conception was 29.6 ± 4.9 kg/m2. The average weight gain during pregnancy was 8.9 kg. Preeclampsia appeared in 2.7 %, gestational diabetes (GD) in 5.7 % and cesarean delivery was performed at 42.5 %. Small for gestational age (SGA) neonates were diagnosed in 15.8 % and large for gestational age (LGA) neonates in 3.7 %. Limited data exist on the subject and further prospective studies are needed to prove the exact evidence of relation between LSG and pregnancy outcomes. Initial studies show that patients with LSG present lower rates of GD and LGA neonates, higher rates of SGA neonates and similar rates of hypertensive disorders and prematurity when compared to non operated controls. Time interval between LSG and conception is not proven to have a statistically significant impact on maternal or neonatal outcomes.

Curbing Obesity from One Generation to Another: the Effects of Bariatric Surgery on the In Utero Environment and Beyond

Approximately 250,000 individuals seek bariatric surgery each year in the USA for the long-term resolution of obesity-related comorbidities. Greater than 80% of these individuals are women and approximately half are of child-bearing age. Although there are many positive metabolic benefits that are realized through surgical weight loss for both men and women, the various long-term hormonal, molecular, nutrient, and epigenetic changes following bariatric surgery have not been evaluated for the surgical recipient or in the context of pregnancy and the offspring. Pregnancy may be a vulnerable period of time for the bariatric surgery recipient, and thoughtful consideration of pregnancy management should be taken by health care providers and recipients alike. The purpose of this review is to explore potential etiologies of some of the gestation-specific outcomes for the mother and offspring.

Glucose Homeostasis, Fetal Growth and Gestational Diabetes Mellitus in Pregnancy after Bariatric Surgery: A Scoping Review

Background: Pregnancies in women with a history of bariatric surgery are becoming increasingly prevalent. Surgically induced metabolic changes benefit mother and child, but can also lead to some adverse pregnancy outcomes. Knowledge about glucose homeostasis in these pregnancies could elucidate some of the mechanisms behind these outcomes. This review focusses on glucose homeostasis and birth weight. Methods: We considered papers dealing with glucose homeostasis, gestational diabetes mellitus (GDM) and/or small-for-gestational age infants (SGA) in pregnancies with a history of sleeve gastrectomy (SG) or Roux-en-y gastric bypass (RYGB). Results: Since an OGTT is unreliable to diagnose GDM in a pregnancy after bariatric surgery, the true incidence of GDM is unknown. Alternative screening strategies are needed. Furthermore, these pregnancies are marked by frequent hypoglycemic events as well as wide and rapid glycemic excursions, an issue that is very likely underreported. There is a lack of uniformity in reporting key outcomes and a large variation in study design and control population. Conclusion: Alteration of glucose homeostasis in a pregnancy after bariatric surgery should be further studied using unequivocal definition of key concepts. Glycemic control may prove to be a modifiable risk factor for adverse pregnancy outcomes such as the delivery of an SGA baby.

Common and Rare Complications of Bariatric Surgery

As the prevalence of obesity has increased, bariatric surgery has become more common because of its proven efficacy at promoting weight loss and improving weight-related medical comorbidities. Although generally successful, bariatric surgery may also lead to complications and negatively affect health. This article highlights some common and rare complications of bariatric surgery. Specifically, it discusses the risk of nutrient deficiencies (which is influenced by surgery type) and their downstream effects, including ill-effects on bone health. Rarer complications, such as postbypass hypoglycemia and alcohol use disorder, are also discussed.

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

BACKGROUND

Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery.

METHODS

A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards.

RESULTS

Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-to-decision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure.

CONCLUSION

This document summarizes the latest evidence on bariatric surgery through state-of-the art guideline development, aiming to facilitate evidence-based clinical decisions.

Pregnancy After Bariatric Surgery: a Comparative Study of Post-Bariatric Pregnant Women Versus Non-Bariatric Obese Pregnant Women

PURPOSE

To evaluate the impact of bariatric surgery on the gestational outcomes.

MATERIALS AND METHODS

Retrospective study of pregnant women hospitalized for delivery in the maternity in Curitiba, Brazil, who had a body mass index (BMI) greater than or equal to 30 kg/m² and/or who had undergone bariatric surgery. Interviews were performed, and the patients' medical records and antenatal information cards were evaluated.

RESULTS

Ninety-three pregnant women who had bariatric surgery and 205 obese pregnant women were selected. A lower occurrence of hypertensive diseases was observed in pregnant women who had undergone bariatric surgery (14%) compared with obese pregnant women (56.6%). Moreover, a reduced occurrence of diabetes was found in post-bariatric pregnant women (16.1%) compared with obese pregnant women (30.2%). There were no differences in the frequency of prematurity, in delivery methods, or in postpartum complications. There was a higher number of cases of babies who were small for gestational age and a lower number of babies who were large for gestational age in the post-bariatric group. When comparing obese pregnant women to post-bariatric pregnant women who had remained obese, a reduced frequency of hypertensive diseases and diabetes was found in the latter group, but the weight difference between their newborns was not statistically significant.

CONCLUSION

There was a lower occurrence of health-related issues complicating pregnancy among women who had undergone bariatric surgery, but these women's newborns were more likely to be small for gestational age, a finding which was less significant the less weight the mother had lost.

Timing of Gestation After Laparoscopic Sleeve Gastrectomy (LSG): Does It Influence Obstetrical and Neonatal Outcomes of Pregnancies?

AIM

We aimed to evaluate the effect of pregnancy timing after laparoscopic sleeve gastrectomy (LSG) on maternal and fetal outcomes.

METHODS

Women with LSG were stratified into two groups with surgery-to-conception intervals of ≤ 18 months (early group) or > 18 months (late group). Only the first delivery after LSG was included in this study. We compared maternal characteristics, pregnancy, and neonatal outcomes and adherence to the Institute of Medicine's (IOM) recommendations for gestational weight gain (GWG) in the two groups.

RESULTS

Fifteen patients conceived ≤ 18 months after surgery, with a mean surgery-to-conception interval of 5.6 ± 4.12 months, and 29 women conceived > 18 months following LSG, with a mean surgery-to-conception interval of 32.31 ± 11.38 months, p < 0.05. There was no statistically significant difference between the two groups regarding birth weight, gestational age, cesarean deliveries (CD), preterm birth, whether their child was small or large for their gestational age, or in the need of neonatal intensive care. There was no correlation between mean weight loss from operation till conception, mean weight gain during pregnancy, and mean body mass index (BMI) at conception between birth weight in either study group. Inadequate and normal GWG was significantly higher in the early group, whereas excessive GWG was significantly higher in the late group (X², 20.780; p = < 0.001).

CONCLUSION

The interval between LSG and conception did not impact maternal and neonatal outcomes. Pregnancy after LSG was overall safe and well-tolerated.

The advantages and disadvantages of sleeve gastrectomy; clinical laboratory to bedside review

Sleeve gastrectomy is a surgical technique and a leading method in metabolic surgery. Sleeve gastrectomy gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery and has proved to be a successful method in achieving considerable weight loss in a short time. There are some disparate effects that patients may experience after sleeve gastrectomy including a reduction in BMI, weight, blood pressure, stroke, and cancer and also a significant remission in obesity-related diseases including type 2 diabetes (T2D), Non-alcoholic fatty liver (NAFLD), cardiovascular disease, obstructive sleep apnea, and craniopharyngioma-related hypothalamic obesity as well as non-obesity-related diseases such as gout, musculoskeletal problems, ovarian disorders and urinary incontinence. The most common complications of sleeve gastrectomy are bleeding, nutrient deficiencies, and leakage. There are several studies on the impact of gender and ethnic disparities on post-operative complications. This study collects state of the art of reports on sleeve gastrectomy. The aim of this study was to analyze recent studies and review the advantages and disadvantages of sleeve gastrectomy.

Effects of laparoscopic sleeve gastrectomy on obstetric outcomes within 12 months after surgery

AIM

To determine the obstetric and neonatal outcomes of pregnant patients having undergone laparoscopic sleeve gastrectomy (LSG) in the previous 12 months.

METHODS

This retrospective and observational study included 144 pregnant women: 48 had pregnancies within 12 months after LSG (Group A), 42 became pregnant more than 1 year after surgery (Group B) and 54 obese pregnant women who had a body mass index (BMI) >30 kg/m² , were categorized as the control group because they did not undergo surgery (Group C). The participants' early gestational BMI, predelivery BMI and gestational weight gain were determined and the obstetric and neonatal outcomes of the groups were compared.

RESULTS

The time interval from surgery to conception was 7.8 ± 3.4 months and 25.8 ± 13.4 months for Groups A and B, respectively (P < 0.01). There were no significant differences in the rates of gestational hypertension, pre-eclampsia, preterm delivery and cesarean section between the groups. The number of patients with gestational diabetes mellitus was significantly higher in Group C than in Groups A and B (P = 0.004). The number of large-for-gestational-age infants was higher in Group C than in Groups A and B (P = 0.046). The number of small-for-gestational-age infants was significantly higher in Group A than in Groups B and C (P = 0.025).

CONCLUSION

Pregnancy within one year after LSG is related to an increased risk of small-for-gestational-age infants. LSG decreases the risk of gestational diabetes mellitus independent of the time interval between surgery and conception.