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Adverse Neonatal and Obstetric Outcomes in a 20-year Brazilian Retrospective Cohort of Pregnancies after Bariatric Surgery

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Abstract

Purpose

Evaluation of obstetric and neonatal outcomes in a Brazilian retrospective cohort of pregnancies after Roux-en-Y gastric bypass (RYGB), regarding the 2009 Institute of Medicine (IOM) recommendations about gestational weight gain (GWG) and RYGB-conception interval. Additionally, search for intrapopulation risk factors for small gestational age (SGA) offspring and mental health assessments.

Material and methods

Retrospective analysis of 132 singleton pregnancies after RYGB. Obstetric and neonatal outcomes were analyzed with stratification in above, below, or meeting the target regarding GWG guidance, and 0–12, 12–47, and ≥48 months for RYGB-conception interval. SGA risk factors were identified through Poisson regression analysis.

Results

GWG below the recommendations was associated with prematurity (p 0.003). Late conceptions (≥48 months) were associated with iron deficiency (p 0.025). Parenteral iron prescription was a protective factor for SGA, with a relative risk of 0.41 (95% CI, 0.20–0.85; p 0.017), and GWG below target was a SGA risk factor, with a relative risk of 4.68 (95% CI, 1.48–14.8; p 0.008). In all, 15.2% of patients had psychopharmacological treatment during pregnancy, and 7.6% received a diagnosis of postpartum depression. Any alcohol and tobacco consumption were reported in 3.8 and 6.8% of patients, respectively.

Conclusion

The recommendations regarding GWG apply to the RYGB population, and surgery-conception intervals should be individualized. The parenteral iron prescription was a protective factor for SGA, and GWG below the recommendations of the IOM was a risk factor for SGA. Psychological and psychiatric care should be offered to every possible pregnancy after RYGB.

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Acknowledgements

For showing relentless aid in the organization and search of medical records, encouraging and making this publication feasible, we sincerely thank Ms. Rejane von Muhlen from the Center for Obesity and Metabolic Syndrome, São Lucas Hospital, Porto Alegre, Rio Grande do Sul, Brazil. We are also thankful to Ms. Ceres Andreia Vieira de Oliveira for the statistical advice.

Funding

This work was funded in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001. The authors declared no other financial support for the research and publication of this article.

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Authors and Affiliations

  1. São Lucas Hospital, Porto Alegre, RS, Brazil

    Leonardo B. Walter, Dânia Dolzan & Thais Areias

  2. Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada

    Carolina G. Bergmann

  3. Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil

    Carolina G. Bergmann, Cláudio C. Mottin & Alexandre V. Padoin

  4. Center for Obesity and Metabolic Syndrome, São Lucas Hospital, Porto Alegre, RS, Brazil

    Jacqueline Rizzolli, Cláudio C. Mottin & Alexandre V. Padoin

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  1. Leonardo B. Walter
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  2. Dânia Dolzan
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Correspondence to Leonardo B. Walter.

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All procedures performed in studies involving human participants were in accordance with the institutional and national research committee’s ethical standards and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.

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Walter, L.B., Dolzan, D., Areias, T. et al. Adverse Neonatal and Obstetric Outcomes in a 20-year Brazilian Retrospective Cohort of Pregnancies after Bariatric Surgery. OBES SURG 31, 2859–2868 (2021). https://doi.org/10.1007/s11695-021-05369-y

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