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Obstetrical and Neonatal Outcomes of Pregnancies following Gastric Bypass Surgery: A Retrospective Cohort Study in a French Referral Centre

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Abstract

Background

The objective of this study was to analyze obstetrical and neonatal outcomes following Roux en Y Gastric Bypass procedures (RYGBP).

Methods

A retrospective cohort study was conducted in a single French tertiary perinatal care and bariatric center. The study involved 24 pregnancies, following RYGBP (exposed group) and two different control groups (non-exposed groups). A body mass index (BMI)-matched control group included 120 pregnancies matched for age, parity, and pregnancy BMI. A normal BMI control group included 120 pregnancies with normal BMI (18.5–24.9 kg/m2), matched for age and parity. Hospital data were reviewed from all groups in the same 6-year period. Obstetrical and neonatal outcomes after RYGB were compared, separately, to the two different-matched control groups.

Results

The median interval from RYGBP to conception was 26.6 (range: 3–74) months. Rates of perinatal complications did not differ significantly between the RYGBP group and normal BMI and BMI-matched controls groups. The rate of Cesarean section before labor was higher in the RYGBP patients than in the normal BMI control group (25% vs. 9.3% respectively, p = 0.04). Weight gain was lower in the RYGBP patients than normal BMI control group (5.8 kg vs. 13.2 kg respectively, p < 0.0001). Birthweight was also lower in the RYGBP group than those in normal BMI and BMI-matched controls groups (2,948.2 g vs. 3,368.2 g and 3,441.8 g, respectively, p < 0.0001).

Conclusions

RYGBP surgery was associated with reduced birthweight, suggesting a possible role of nutritional growth restriction in pregnancy.

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References

  1. Schoenborn CA, Adams PF, Barnes PM. Body weight status of adults: United States, 1997–98. Adv Data. 2002;330:1–15.

    PubMed  Google Scholar 

  2. Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: complications and cost. Am J Clin Nutr. 2000;71(5 Suppl):1242S–8.

    CAS  PubMed  Google Scholar 

  3. ObEpi-Enquête épidémiologique nationale sur le surpoids et l’obésité. Enquête INSERM/TNS HEALTHCARE(KANTARHEALTH)/ROCHE 2009.

  4. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol. 2005; 106 (3):671–675.

    Google Scholar 

  5. Garbaciak Jr JA, Richter M, Miller S, et al. Maternal weight and pregnancy complications. Am J Obstet Gynecol. 1985;152(2):238–45.

    PubMed  Google Scholar 

  6. Buchwald H. Overview of bariatric surgery. J Am Coll Surg. 2002;194(3):367–75.

    Article  PubMed  Google Scholar 

  7. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  8. Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.

    Article  CAS  PubMed  Google Scholar 

  9. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  PubMed  Google Scholar 

  10. Miller RS, Thompson ML, Williams MA. Trimester-specific blood pressure levels in relation to maternal pre-pregnancy body mass index. Paediatr Perinat Epidemiol. 2007;21(6):487–94.

    Article  PubMed  Google Scholar 

  11. Teitelman M, Grotegut CA, Williams NN, et al. The impact of bariatric surgery on menstrual patterns. Obes Surg. 2006;16(11):1457–63.

    Article  PubMed  Google Scholar 

  12. Wax JR, Heersink D, Pinette MG, et al. Symptomatic hypoglycemia complicating pregnancy following Roux-en-Y gastric bypass surgery. Obes Surg. 2007;17(5):698–700.

    Article  PubMed  Google Scholar 

  13. Roehrig HR, Xanthakos SA, Sweeney J, et al. Pregnancy after gastric bypass surgery in adolescents. Obes Surg. 2007;17(7):873–7.

    Article  PubMed  Google Scholar 

  14. Weintraub AY, Levy A, Levi I, et al. Effect of bariatric surgery on pregnancy outcome. Int J Gynaecol Obstet. 2008;103(3):246–51.

    Article  PubMed  Google Scholar 

  15. Sheiner E, Levy A, Silverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol. 2004;190(5):1335–40.

    Article  PubMed  Google Scholar 

  16. ACOG. ACOG practice bulletin no 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113(6):1405–13.

    Google Scholar 

  17. Lonroth H, Dalenback J, Haglind E, et al. Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc. 1996;10(6):636–8.

    Article  CAS  PubMed  Google Scholar 

  18. Msika S. Surgical treatment of morbid obesity by gastrojejunal bypass using laparoscopic roux-en-Y (gastric short circuit). J Chir (Paris). 2002;139(4):214–7.

    CAS  Google Scholar 

  19. Zhang J, Gilles JM, Barnhart K, et al. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med. 2005;353(8):761–9.

    Article  CAS  PubMed  Google Scholar 

  20. Chauhan SP, Gupta LM, Hendrix NW, et al. Intrauterine growth restriction: comparison of American College of Obstetricians and Gynecologists practice bulletin with other national guidelines. Am J Obstet Gynecol. 2009;200(4):409.e1–6.

    Article  Google Scholar 

  21. Salomon LJ, Bernard JP, de Stavola B, et al. Birth weight and size: charts and equations. J Gynecol Obstet Biol Reprod (Paris). 2007;36(1):50–6.

    Google Scholar 

  22. Patel JA, Patel NA, Thomas RL, et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(1):39–45.

    Article  PubMed  Google Scholar 

  23. Richards DS, Miller DK, Goodman GN. Pregnancy after gastric bypass for morbid obesity. J Reprod Med. 1987;32(3):172–6.

    CAS  PubMed  Google Scholar 

  24. Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol. 2004;191(3):964–8.

    Article  CAS  PubMed  Google Scholar 

  25. Getahun D, Ananth CV, Peltier MR, et al. Changes in prepregnancy body mass index between the first and second pregnancies and risk of large-for-gestational-age birth. Am J Obstet Gynecol. 2007;196(6):530.e1–8.

    Article  Google Scholar 

  26. Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology. 1991;181(1):129–33.

    CAS  PubMed  Google Scholar 

  27. Mamelle N, Boniol M, Riviere O, et al. Identification of newborns with fetal growth restriction (FGR) in weight and/or length based on constitutional growth potential. Eur J Pediatr. 2006;165(10):717–25.

    Article  PubMed  Google Scholar 

  28. Ego A, Subtil D, Grange G, et al. Customized versus population-based birth weight standards for identifying growth restricted infants: a French multicenter study. Am J Obstet Gynecol. 2006;194(4):1042–9.

    Article  PubMed  Google Scholar 

  29. Gardosi J, Clausson B, Francis A. The use of customised versus population-based birthweight standards in predicting perinatal mortality. BJOG. 2007;114(10):1301–2. author reply 1303.

    Article  CAS  PubMed  Google Scholar 

  30. Siega-Riz AM, Viswanathan M, Moos MK, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339.e1–14.

    Article  Google Scholar 

  31. Wittgrove AC, Jester L, Wittgrove P, et al. Pregnancy following gastric bypass for morbid obesity. Obes Surg. 1998;8(4):461–4. discussion 465–6.

    Article  CAS  PubMed  Google Scholar 

  32. Sheiner E, Balaban E, Dreiher J, et al. Pregnancy outcome in patients following different types of bariatric surgeries. Obes Surg. 2009;19(9):1286–92.

    Article  PubMed  Google Scholar 

  33. Wax JR, Cartin A, Wolff R, et al. Pregnancy following gastric bypass surgery for morbid obesity: maternal and neonatal outcomes. Obes Surg. 2008;18(5):540–4.

    Article  PubMed  Google Scholar 

  34. Dao T, Kuhn J, Ehmer D, et al. Pregnancy outcomes after gastric-bypass surgery. Am J Surg. 2006;192(6):762–6.

    Article  PubMed  Google Scholar 

  35. Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009;15(2):189–201.

    Article  PubMed  Google Scholar 

  36. Wax JR, Cartin A, Wolff R, et al. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008;18(12):1517–21.

    Article  PubMed  Google Scholar 

  37. Rand CS, Macgregor AM. Medical care and pregnancy outcome after gastric bypass surgery for obesity. South Med J. 1989;82(10):1319–20.

    CAS  PubMed  Google Scholar 

  38. Kramer MS, Seguin L, Lydon J, et al. Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatr Perinat Epidemiol. 2000;14(3):194–210.

    Article  CAS  PubMed  Google Scholar 

  39. Hofhuis W, de Jongste JC, Merkus PJ. Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Arch Dis Child. 2003;88(12):1086–90.

    Article  CAS  PubMed  Google Scholar 

  40. Barker DJ, Eriksson JG, Forsen T, et al. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol. 2002;31(6):1235–9.

    Article  CAS  PubMed  Google Scholar 

  41. Park JH, Stoffers DA, Nicholls RD, et al. Development of type 2 diabetes following intrauterine growth retardation in rats is associated with progressive epigenetic silencing of Pdx1. J Clin Invest. 2008;118(6):2316–24.

    CAS  PubMed  Google Scholar 

  42. Faintuch J, Matsuda M, Cruz ME, et al. Severe protein-calorie malnutrition after bariatric procedures. Obes Surg. 2004;14(2):175–81.

    Article  PubMed  Google Scholar 

  43. Woodard CB. Pregnancy following bariatric surgery. J Perinat Neonatal Nurs. 2004;18(4):329–40.

    PubMed  Google Scholar 

  44. Folope V, Coeffier M, Dechelotte P. Nutritional deficiencies associated with bariatric surgery. Gastroentérol Clin Biol. 2007;31(4):369–77.

    Article  PubMed  Google Scholar 

  45. Eerdekens A, Debeer A, Van Hoey G, et al. Maternal bariatric surgery: adverse outcomes in neonates. Eur J Pediatr. 2009;69(2):191–6.

    Google Scholar 

  46. Haddow JE, Hill LE, Kloza EM, et al. Neural tube defects after gastric bypass. Lancet. 1986;1(8493):1330.

    Article  CAS  PubMed  Google Scholar 

  47. Martin L, Chavez GF, Adams Jr MJ, et al. Gastric bypass surgery as maternal risk factor for neural tube defects. Lancet. 1988;1(8586):640–1.

    Article  CAS  PubMed  Google Scholar 

  48. Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19(1):56–65.

    Article  PubMed  Google Scholar 

  49. Ahmed AR, O’Malley W. Internal hernia with Roux loop obstruction during pregnancy after gastric bypass surgery. Obes Surg. 2006;16(9):1246–8.

    Article  PubMed  Google Scholar 

  50. Charles A, Domingo S, Goldfadden A, et al. Small bowel ischemia after Roux-en-Y gastric bypass complicated by pregnancy: a case report. Am Surg. 2005;71(3):231–4.

    PubMed  Google Scholar 

  51. Kakarla N, Dailey C, Marino T, et al. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol. 2005;105(5 Pt 2):1195–8.

    PubMed  Google Scholar 

  52. Moore KA, Ouyang DW, Whang EE. Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med. 2004;351(7):721–2.

    Article  CAS  PubMed  Google Scholar 

  53. Wang CB, Hsieh CC, Chen CH, et al. Strangulation of upper jejunum in subsequent pregnancy following gastric bypass surgery. Taiwan J Obstet Gynecol. 2007;46(3):267–71.

    Article  CAS  PubMed  Google Scholar 

  54. Wax JR, Wolff R, Cobean R, et al. Intussusception complicating pregnancy following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(7):977–9.

    Article  PubMed  Google Scholar 

  55. Loar 3rd PV, Sanchez-Ramos L, Kaunitz AM, et al. Maternal death caused by midgut volvulus after bariatric surgery. Am J Obstet Gynecol. 2005;193(5):1748–9.

    Article  PubMed  Google Scholar 

  56. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104(3):647–51.

    Google Scholar 

  57. Galtier-Dereure F, Montpeyroux F, Boulot P, et al. Weight excess before pregnancy: complications and cost. Int J Obes Relat Metab Disord. 1995;19(7):443–8.

    CAS  PubMed  Google Scholar 

  58. Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus. Diab Care. 2007;30(8):2070–6.

    Article  Google Scholar 

  59. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103(2):219–24.

    PubMed  Google Scholar 

  60. O’Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003;14(3):368–74.

    Article  PubMed  Google Scholar 

  61. Galtier-Dereure F, Bringer J. Maternal overweight and pregnancy. Diabetes Metab. 1997;23(6):549–53.

    CAS  PubMed  Google Scholar 

  62. Getahun D, Ananth CV, Oyelese Y, et al. Primary preeclampsia in the second pregnancy: effects of changes in prepregnancy body mass index between pregnancies. Obstet Gynecol. 2007;110(6):1319–25.

    PubMed  Google Scholar 

  63. Ehrenberg HM, Durnwald CP, Catalano P, et al. The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol. 2004;191(3):969–74.

    Article  CAS  PubMed  Google Scholar 

  64. Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo Cesarean delivery. Obstet Gynecol. 2002;100(5 Pt 1):959–64.

    Article  PubMed  Google Scholar 

  65. Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25(8):1175–82.

    Article  CAS  PubMed  Google Scholar 

  66. Usha Kiran TS, Hemmadi S, Bethel J, et al. Outcome of pregnancy in a woman with an increased body mass index. BJOG. 2005;112(6):768–72.

    Article  CAS  PubMed  Google Scholar 

  67. Callaway LK, Prins JB, Chang AM, et al. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust. 2006;184(2):56–9.

    PubMed  Google Scholar 

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Acknowledgments

The authors express their sincere appreciation to Stefano Scaringi M.D. and Marie-Françoise Guyomar for data acquisition.

Contribution to Authorship

LM and PS carried out the study concept and design. EF, CD and PS were responsible for acquisition of the data. PS, LM, SL, and SM carried out the analysis and interpretation of data. PS, LM, and EF drafted the manuscript. LM and SM supervised the study.

Details of Ethics Approval

The study was approved by the institutional review board (Comité d’évaluation de l’éthique des projets de recherché biomédicale du GHU Nord, IRB N°00006477) as project N° 09-050 on November 6, 2009.

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Correspondence to Laurent Mandelbrot.

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Santulli, P., Mandelbrot, L., Facchiano, E. et al. Obstetrical and Neonatal Outcomes of Pregnancies following Gastric Bypass Surgery: A Retrospective Cohort Study in a French Referral Centre. OBES SURG 20, 1501–1508 (2010). https://doi.org/10.1007/s11695-010-0260-6

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