Re: How should women be advised on weight management in pregnancy?
Whereas maternal obesity increases the risk of pregnancy complications including miscarriage, foetal abnormality, hypertension, diabetes, thrombosis, difficulty in delivery leading to higher caesarean rates, and infection [1-4], rates of adverse maternal and neonatal outcomes are lower in women who become pregnant following bariatric surgery [4,5]. Although women are generally advised to avoid pregnancy for 12 – 24 months after bariatric surgery due to fears of foetal under-nutrition and reduced weight loss benefits [3,4], little is known of the effect of gestation on weight loss outcomes.
We identified 232 women of childbearing age (18 – 45 years) from an automated database that included 730 obese people who had undergone bariatric surgery at our institution. Mean ± standard deviation (s.d.) age was 34.0 ± 5.9 years, pre-operative weight 137.7 ± 21.3 kg and body mass index (BMI; the weight in kilograms divided by the square of the height in metres) 50.6 ± 7.2 kg/m2. One-hundred and ninety-seven women (84.9%) had undergone Roux-en-Y gastric bypass surgery, 19 (8.2%) adjustable gastric banding, eight (3.4%) sleeve gastrectomy and eight (3.4%) other procedures.
Twenty-one women became pregnant following bariatric surgery. They were younger at the time of surgery compared to women in the non-pregnancy group with mean ± s.d. age of 28.0 ± 5.4 vs. 34.6 ± 5.6 years, respectively (P < 0.001). The two groups were otherwise well matched in pre-operative weight (136.5 ± 18.5 vs. 137.8 ± 21.6 kg, non-significant (ns)), BMI (49.2 ± 7.4 vs. 50.7 ± 7.2 kg/m2, ns) and type of bariatric procedure. The time to first pregnancy was a median 11 (range, 1.5 – 36) months following bariatric surgery and was planned in six women (28.6%). Eighteen women (86%) completed pregnancy successfully; live birth was achieved by vaginal route in 12 (57%) and caesarean section in six (29%); two women (9%) undertook medical termination of pregnancy and one (5%) suffered a spontaneous miscarriage.
Both groups of women achieved significant weight loss after bariatric surgery (Figure 1). Women in the pregnancy group lost 70.4% of excess weight (the difference of pre-operative weight and ideal body weight based on a BMI of 25 kg/m2) compared to 70.0% in the non-pregnancy group at median 30 months of follow-up (ns).
We conclude that pregnancy after bariatric surgery in women of childbearing age is safe and does not adversely influence weight loss outcomes. However, close surveillance of maternal weight and nutritional status is advisable, particularly if conception occurs in the first 12 months following bariatric surgery.
Aderinsola Alatishe medical student
Basil J. Ammori consultant laparoscopic bariatric surgeon and honorary professor of surgery
Akheel A. Syed consultant endocrinologist and honorary senior lecturer
Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester M6 8HD and The University of Manchester, Oxford Road, Manchester M13 9PL aas@drsyed.org
Acknowledgements
Permission was obtained from the Caldicott Guardian of our institution.
References
1. Poston L, Chappell LC. How should women be advised on weight management in pregnancy? BMJ 2012;344:e2774.
2. Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK: Findings from a national project. London: CMACE, 2010.
3. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: Bariatric surgery and pregnancy. Obstet Gynecol 2009;113(6):1405-13.
4. Wax JR. Risks and management of obesity in pregnancy: current controversies. Curr Opin Obstet Gynecol 2009;21(2):117-23.
5. Maggard MA, Yermilov I, Li Z, Maglione M, Newberry S, Suttorp M, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA 2008;300(19):2286-96.
Figure
Figure 1. Weight loss outcomes in pregnancy and non-pregnancy groups of women of childbearing age following bariatric surgery. Excess weight was the difference of the pre-operative body weight and the ideal body weight needed to achieve the reference standard body mass index of 25 kg/m2. Error bars represent standard error of the mean.
Competing interests:
No competing interests
10 September 2012
Aderinsola Alatishe
Medical Student
Basil J. Ammori consultant laparoscopic bariatric surgeon and honorary professor of surgery, Akheel A. Syed consultant endocrinologist and honorary senior lecturer
Rapid Response:
Re: How should women be advised on weight management in pregnancy?
Whereas maternal obesity increases the risk of pregnancy complications including miscarriage, foetal abnormality, hypertension, diabetes, thrombosis, difficulty in delivery leading to higher caesarean rates, and infection [1-4], rates of adverse maternal and neonatal outcomes are lower in women who become pregnant following bariatric surgery [4,5]. Although women are generally advised to avoid pregnancy for 12 – 24 months after bariatric surgery due to fears of foetal under-nutrition and reduced weight loss benefits [3,4], little is known of the effect of gestation on weight loss outcomes.
We identified 232 women of childbearing age (18 – 45 years) from an automated database that included 730 obese people who had undergone bariatric surgery at our institution. Mean ± standard deviation (s.d.) age was 34.0 ± 5.9 years, pre-operative weight 137.7 ± 21.3 kg and body mass index (BMI; the weight in kilograms divided by the square of the height in metres) 50.6 ± 7.2 kg/m2. One-hundred and ninety-seven women (84.9%) had undergone Roux-en-Y gastric bypass surgery, 19 (8.2%) adjustable gastric banding, eight (3.4%) sleeve gastrectomy and eight (3.4%) other procedures.
Twenty-one women became pregnant following bariatric surgery. They were younger at the time of surgery compared to women in the non-pregnancy group with mean ± s.d. age of 28.0 ± 5.4 vs. 34.6 ± 5.6 years, respectively (P < 0.001). The two groups were otherwise well matched in pre-operative weight (136.5 ± 18.5 vs. 137.8 ± 21.6 kg, non-significant (ns)), BMI (49.2 ± 7.4 vs. 50.7 ± 7.2 kg/m2, ns) and type of bariatric procedure. The time to first pregnancy was a median 11 (range, 1.5 – 36) months following bariatric surgery and was planned in six women (28.6%). Eighteen women (86%) completed pregnancy successfully; live birth was achieved by vaginal route in 12 (57%) and caesarean section in six (29%); two women (9%) undertook medical termination of pregnancy and one (5%) suffered a spontaneous miscarriage.
Both groups of women achieved significant weight loss after bariatric surgery (Figure 1). Women in the pregnancy group lost 70.4% of excess weight (the difference of pre-operative weight and ideal body weight based on a BMI of 25 kg/m2) compared to 70.0% in the non-pregnancy group at median 30 months of follow-up (ns).
We conclude that pregnancy after bariatric surgery in women of childbearing age is safe and does not adversely influence weight loss outcomes. However, close surveillance of maternal weight and nutritional status is advisable, particularly if conception occurs in the first 12 months following bariatric surgery.
Aderinsola Alatishe medical student
Basil J. Ammori consultant laparoscopic bariatric surgeon and honorary professor of surgery
Akheel A. Syed consultant endocrinologist and honorary senior lecturer
Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester M6 8HD and The University of Manchester, Oxford Road, Manchester M13 9PL
aas@drsyed.org
Acknowledgements
Permission was obtained from the Caldicott Guardian of our institution.
References
1. Poston L, Chappell LC. How should women be advised on weight management in pregnancy? BMJ 2012;344:e2774.
2. Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK: Findings from a national project. London: CMACE, 2010.
3. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: Bariatric surgery and pregnancy. Obstet Gynecol 2009;113(6):1405-13.
4. Wax JR. Risks and management of obesity in pregnancy: current controversies. Curr Opin Obstet Gynecol 2009;21(2):117-23.
5. Maggard MA, Yermilov I, Li Z, Maglione M, Newberry S, Suttorp M, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA 2008;300(19):2286-96.
Figure
Figure 1. Weight loss outcomes in pregnancy and non-pregnancy groups of women of childbearing age following bariatric surgery. Excess weight was the difference of the pre-operative body weight and the ideal body weight needed to achieve the reference standard body mass index of 25 kg/m2. Error bars represent standard error of the mean.
Competing interests: No competing interests