In Australia, bariatric procedures doubled between 2005 and 2015 with 80% of surgeries performed on women of child bearing age [1]. Pregnancy following bariatric surgery is associated with mixed maternal and fetal outcomes. Limited data are available regarding pregnancy outcomes after laparoscopic sleeve gastrectomy.
A statewide hospital and perinatal data register linked cohort matched study was performed. In total, 2,018 births in 1,677 women with prior maternal bariatric surgery were registered in the Queensland Hospital Admitted Patient Data Collection and matched with deliveries during 2013-2018 in the Perinatal Data Collection. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Women were excluded if BMI was missing or if bariatric surgery procedures had been reversed, revised or ambiguously coded. A total of n=1282 cases and n=12820 controls were analyzed matched on BMI, smoking, age and parity. Continuous variables were analyzed using paired t-tests and categorical variables were analyzed using Pearson’s Chi-square or Fisher’s exact test.
Of 1282 women with a singleton delivery after bariatric surgery, 93% had undergone laparoscopic sleeve gastrectomy. In women with previous bariatric surgery, there was more assisted reproductive technology use (10.7% vs 8.0%, p<0.001) and preterm birth (<37 weeks) (10.5% vs 7.8%; p=0.007). Offspring had lower absolute birthweight (3223g ± 605g vs 3418g ± 595g; p<0.001), lower percent of large for gestational age (LGA) (8.6% vs 14.1%; p<0.001) and higher percent of SGA infants (10.7% vs 7.3%; p<0.001) than offspring born to matched women. Percent of GDM was lower in women with previous bariatric surgery (15% vs 20%; p<0.001).
Glycaemic and metabolic shifts caused by pre-pregnancy bariatric surgery modify obesity associated pregnancy and neonatal outcomes. Our results suggest that pregnancy outcomes following maternal bariatric surgery differ from matched controls in a cohort of women with primarily gastric sleeve surgery.