Advertisement

Obesity Surgery

, Volume 28, Issue 11, pp 3559–3566 | Cite as

Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes

  • Cátia Rasteiro
  • Célia Araújo
  • Sara Cunha
  • Rita Caldas
  • Joana Mesquita
  • Adérito Seixas
  • Nuno Augusto
  • Carla Ramalho
Original Contributions

Abstract

Introduction

Pregnancy in women submitted to bariatric surgery is increasing. Recommendations for surveillance of these pregnancies have been suggested, but an adequate time interval from surgery to conception, to avoid perinatal negative outcomes, is still controversial.

Material and Methods

Medical records of pregnancies in women with previous bariatric surgery were retrieved and outcomes were assessed according to three different time thresholds (12, 18 and 24 months). The association between time from surgery to conception and the presence of adverse outcomes was analysed.

Results

Eighty-six pregnancies were assessed. Weight gain was higher (p = 0.014) and more adequate (p = 0.041) when pregnancy occurred more than 12 months after surgery. Foetal growth percentile was lower when pregnancy was achieved before 24 months following surgery (p = 0.021). No differences among groups were found in other assessed outcomes (BMI, gestational age at delivery, type of delivery, gestational diabetes, pregnancy hypertensive disease, anaemia, preterm delivery, foetal weight, foetal growth restriction, Apgar score, admission to neonatal intensive unit) in all considered thresholds. No association between time from surgery to conception and the presence of adverse outcomes was found.

Conclusion

Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.

Keywords

Obesity Pregnancy Bariatric surgery Surgery to conception time interval 

Notes

Acknowledgments

Cátia Rasteiro, as principal investigator, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Statement of Human and Animal Rights

Not Applicable.

Statement of Informed Consent

For this type of study, formal consent is not required.

References

  1. 1.
    Organisation for Economic Co-operation and Development. Obesity Update 2017. 2017.Google Scholar
  2. 2.
    do Carmo I, Dos Santos O, Camolas J, et al. Overweight and obesity in Portugal: national prevalence in 2003-2005. Obes Rev. 2008;9(1):11–9.PubMedGoogle Scholar
  3. 3.
    Sardinha LB, Santos DA, Silva AM, et al. Prevalence of overweight, obesity, and abdominal obesity in a representative sample of Portuguese adults. PLoS One. 2012;7(10):e47883.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mission JF, Marshall NE, Caughey AB. Pregnancy risks associated with obesity. Obstet Gynecol Clin N Am. 2015;42(2):335–53.CrossRefGoogle Scholar
  5. 5.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018;218(6):573–80.CrossRefPubMedGoogle Scholar
  8. 8.
    Kassir R, Goiset MP, Williet N, et al. Bariatric surgery and pregnancy: what outcomes? Int J Surg. 2016;36(Pt A):66–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(9):814–24.CrossRefPubMedGoogle Scholar
  10. 10.
    American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113(6):1405–13.CrossRefGoogle Scholar
  11. 11.
    Alatishe A, Ammori BJ, New JP, et al. Bariatric surgery in women of childbearing age. QJM. 2013;106(8):717–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Apovian CM, Baker C, Ludwig DS, et al. Best practice guidelines in pediatric/adolescent weight loss surgery. Obes Res. 2005;13(2):274–82.CrossRefPubMedGoogle Scholar
  13. 13.
    Monteiro M. Comment on: pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. Surg Obes Relat Dis. 2017;13(11):1905–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Royal College of Obstetricians & Gynaecologists. The role of bariatric surgery in improving reproductive health. 2015.Google Scholar
  15. 15.
    Carreau A-M, Nadeau M, Marceau S, et al. Pregnancy after bariatric surgery: balancing risks and benefits. Can J Diabetes. 2017;41(4):432–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Menard MK, Kilpatrick S, Saade G, et al. Levels of maternal care. Am J Obstet Gynecol. 2015;212(3):259–71.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    Kjær MM, Nilas L. Timing of pregnancy after gastric bypass—a national register-based cohort study. Obes Surg. 2013;23(8):1281–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Stentebjerg LL, Andersen LLT, Renault K, et al. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass. J Matern Fetal Neonatal Med. 2017;30(10):1182–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Yau PO, Parikh M, Saunders JK, et al. Pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. Surg Obes Relat Dis. 2017;13(11):1899–905.CrossRefPubMedGoogle Scholar
  21. 21.
    González I, Rubio MA, Cordido F, et al. Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obes Surg. 2015;25(3):436–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Dao T, Kuhn J, Ehmer D, et al. Pregnancy outcomes after gastric-bypass surgery. Am J Surg. 2006;192(6):762–6.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    Parent B, Martopullo I, Weiss NS, et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg. 2017;152(2):1–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Dalfra MG, Busetto L, Chilelli NC, et al. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med. 2012;25(9):1537–43.CrossRefPubMedGoogle Scholar
  26. 26.
    Chevrot A, Kayem G, Coupaye M, et al. Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol. 2016;214(5):655 e1–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Frame-Peterson LA, Megill RD, Carobrese S, et al. Nutrient deficiencies are common prior to bariatric surgery. Nutr Clin Pract. 2017;32(4):463–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Gesquiere I, Foulon V, Augustijns P, et al. Micronutrient intake, from diet and supplements, and association with status markers in pre- and post-RYGB patients. Clin Nutr. 2017;36(4):1175–81.CrossRefPubMedGoogle Scholar
  29. 29.
    Hue O, Marcotte J, Berrigan F, et al. Increased plasma levels of toxic pollutants accompanying weight loss induced by hypocaloric diet or by bariatric surgery. Obes Surg. 2006;16(9):1145–54.CrossRefPubMedGoogle Scholar
  30. 30.
    Jansen A, Lyche JL, Polder A, et al. Increased blood levels of persistent organic pollutants (POP) in obese individuals after weight loss-a review. Toxicol Environ Health B Crit Rev. 2017;20(1):22–37.CrossRefGoogle Scholar
  31. 31.
    Ducarme G, Parisio L, Santulli P, et al. Neonatal outcomes in pregnancies after bariatric surgery: a retrospective multi-centric cohort study in three French referral centers. J Matern Fetal Neonatal Med. 2013;26(3):275–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Norgaard LN, Gjerris AC, Kirkegaard I, et al. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study. PLoS One. 2014;9(3):e90317.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Mahawar KK, Graham Y, Small PK. Optimum time for pregnancy after bariatric surgery. Surg Obes Relat Dis. 2016;12(5):1126–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centro Hospitalar de Entre o Douro e VougaSanta Maria da FeiraPortugal
  2. 2.Faculdade de Ciências da SaúdeUniversidade da Beira InteriorCovilhãPortugal
  3. 3.Escola Superior de SaúdeUniversidade Fernando PessoaPortoPortugal
  4. 4.LABIOMEP, INEGI-LAETA, Faculty of SportsUniversity of PortoPortoPortugal
  5. 5.Faculdade de Ciências Sociais e HumanasUniversidade da Beira InteriorCovilhãPortugal
  6. 6.Centre for Research and Studies in SociologyUniversity Institute of LisbonLisbonPortugal
  7. 7.Centro Hospitalar São JoãoEPEPortoPortugal
  8. 8.Faculdade de Medicina da Universidade do PortoPortoPortugal
  9. 9.Universidade do PortoInstituto de Investigação e Inovação em SaúdePortoPortugal

Personalised recommendations