Abstract
Background
While obesity presents specific acute and long-term risks to the pregnant woman and
her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined.
Objective
A systematic review was performed according to the Academy of Nutrition and Dietetics
Evidence Analysis Library process to determine the effects of bariatric surgery on
both maternal and infant health outcomes of pregnancy.
Design
A comprehensive literature search of PubMed was conducted to identify studies published
from years 2000 to 2015 that examined the health effects of pregnancy after bariatric
surgery. Experimental studies and observational studies with a control group were
included.
Main outcome measures
Outcomes of interest were gestational weight gain, maternal complications (ie, gestational
diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage
and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories
(ie, macrosomia, low birth weight, small for gestational age, and large for gestational
age), gestational age and preterm birth, infant illness and complications (ie, perinatal
death, admission to neonatal intensive care unit, neonatal illness, and congenital
malformation rates), and Apgar scores.
Results
Thirteen of 246 studies were included. Compared to body mass index–matched controls
without surgery, bariatric surgery before pregnancy reduced infant birth weight in
grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery
did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth,
preterm birth, or infant complications. Effects of surgery on maternal complications,
infant birth weight categories, and surgical delivery rates were inconsistent.
Conclusions
Bariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific
risks may exist. More data are needed to determine clinical guidelines. The long-term
effects of surgery on pregnancy outcomes are unknown.
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Biography
R. I. Al-Nimr is director, Nutrition in Medical Education Program, and a clinical instructor in medicine and medical education, The Geisel School of Medicine, Dartmouth College, Hanover, NH; and a clinical dietitian in research, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Biography
R. Hakeem is a principal, Raana Liaqat Ali Khan Government College of Home Economics, Karachi, Pakistan.
Biography
J. M. Moreschi is a regional extension educator, Supplemental Nutrition Assistance Program Education, Northwest Region, Ottawa, IL.
Biography
S. Gallo is an assistant professor, Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, VA.
Biography
J. M. McDermid is an assistant professor, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville.
Biography
M. Pari-Keener is a clinical dietitian, Outpatient Clinic, Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Biography
B. Stahnke is a Special Supplemental Nutrition Program for Women, Infants, and Children advisory team manager, Georgia Department of Health, Division of Health Promotion, Georgia Special Supplemental Nutrition Program for Women, Infants, and Children Program, Program Integrity and Strategy Unit, Atlanta.
Biography
C. Papoutsakis is senior director, Nutrition and Dietetics Data Science Center, Research, International, and Scientific Affairs, Chicago, IL.
Biography
D. Handu is the senior scientific director, Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL.
Biography
F. W. Cheng is a nutrition researcher, Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL.
Article info
Publication history
Published online: April 27, 2019
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST R. Hakeem is the principal investigator on a research project on the genomic and lifestyle predictors of fetal outcome relevant to diabetes and obesity and their relevance to prevent strategies in South Asia. J. M. McDermid is the co-investigator on the Bill and Melinda Gates Foundation Grant on Early Life Interventions for Childhood Growth and Development in Tanzania. M. Pari-Keener is the past chair (2013) of the Women’s Health Dietetic Practice Group. No potential conflict of interest was reported by the other authors.
FUNDING/SUPPORT Supported by the Academy of Nutrition and Dietetics and the Women's Health Dietetic Practice Group.
Identification
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© 2019 by the Academy of Nutrition and Dietetics.
