Tuesday, March 12, 2013

WLS and Pregnancy: The Risk for Small Babies

Yet another study highlighting the association between Weight Loss Surgery (WLS) and Small-For-Gestational-Age (SGA) babies.  Yes, WLS reduces the number of LGA babies, but it also increases the number of SGA babies, who are more at risk for later health issues.

Am J Obstet Gynecol. 2013 Mar 1. pii: S0002-9378(13)00241-X. doi: 10.1016/j.ajog.2013.02.046. [Epub ahead of print] The risk of adverse pregnancy outcome after bariatric surgery - a nationwide register-based matched cohort study. Kjær MM, Lauenborg J, Breum BM, Nilas L.  PMID: 23467053
OBJECTIVES: The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery. 
STUDY DESIGN: Nationwide register-based matched cohort study of singleton deliveries after bariatric surgery during 2004-2010. Data were extracted from The Danish National Patient Registry and The Medical Birth Register. Each woman with bariatric surgery (exposed) was individually matched with four women without bariatric surgery (unexposed) on BMI, age, parity and date of delivery. Continuous variables were analyzed with the paired t-test and binary outcomes were analyzed by logistic regression. 
RESULTS: We identified 339 women with a singleton delivery after bariatric surgery (84.4% gastric bypass). They were matched to 1277 unexposed women. Infants in the exposed group had shorter mean gestational age (GA) (274 vs. 278 days, p<0.001), lower mean birth weight (3312 vs. 3585 g, p<0.001), lower risk of being large-for-gestational-age (LGA) (AOR 0.31 (95%CI 0.15-0.65)) and higher risk of being small-for-gestational-age (SGA) (AOR 2.29 (95%CI 1.32-3.96)) compared to infants in the unexposed group. No statistically significant difference was found between the groups regarding the risk of gestational diabetes mellitus, preeclampsia, labor induction, cesarean section, postpartum hemorrhage, Apgar score less than seven, admission to neonatal intensive care unit or perinatal death. 
CONCLUSIONS: Infants born after maternal bariatric surgery have lower birth weight, lower GA, 3.3-times lower risk of LGA and 2.3-times higher risk of SGA than infants born by a matched group of women without bariatric surgery. The impact on SGA was even higher in the subgroup with gastric bypass.

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