Bariatric surgery in women may increase risk of abdominal surgery during pregnancy
Women who have undergone weight loss surgery appear to have an increased risk of abdominal surgery during pregnancy, a study suggests.
The national cohort study from Sweden merged data from the Swedish Medical Birth Registry and the Swedish National Patient Registry, evaluating women who had bariatric surgery from 1987 to 2011 in comparison with women in a control group with first-trimester body mass index (BMI) >35 who had not had bariatric surgery.
Primary outcome variables included diagnosis and surgical procedure codes grouped as five outcome categories: 1) intestinal obstruction, 2) gallbladder disease, 3) appendicitis, 4) hernia, and 5) diagnostic laparoscopy or laparotomy without the presence of a diagnosis or surgical code for outcomes in outcome categories 1 to 4.
Multivariate linear regression analysis was used to compute odds ratios (ORs) for each separate pregnancy, whereas general estimating equations with robust variance estimation were used for all pregnancies in a given woman. Factors such as smoking, year of delivery, maternal age and previous abdominal surgery were included as confounders.
Results showed that the rate of surgery for intestinal obstruction during the first pregnancy after bariatric surgery was 1.5 percent (95 percent CI, 1.1 to 2.0) in the case group vs 0.02 percent (0.0 to 0.04) in the control group (adjusted OR, 34.3; 11.9 to 98.7).
Similarly, the rate of diagnostic laparoscopy or laparotomy was higher in the case group than in the control group (1.5 percent; 1.0 to 1.9 vs 0.1 percent; 0.0 to 0.1; adjusted OR, 11.3; 6.9 to 18.5).
According to available evidence, the greatest concern for a pregnancy after bariatric surgery is said to be maternal nutrition, with nutritional deficiencies commonly occurring in pregnancies after the weight-loss procedure. Aside from nutrition, there is also a reported overall trend of increasing caesarean section delivery following bariatric surgery. As there appears to be no physiologic reason for performing more operative deliveries among patients after bariatric surgery, the increased incidence of caesarean deliveries may be attributed to a caregiver bias and should also be interpreted in the context of the increasing caesarean section rate globally. [Semin Perinatol 2011;35:356–361; J Obesity 2011;doi:10.1155/2011/501939]
Given the aforementioned, pregnancy after bariatric surgery should thus be managed using a multidisciplinary approach with an emphasis on consultations from the nutritionist and surgeon. It is also important to include patient education regarding nutrition and clinical management to prevent and detect nutritional deficiencies. [J Clin Endocrinol Metab 2010;95:4823-43]