Obstetric Outcome Following Laparoscopic Adjustable Gastric Banding

Abstract

The bariatric procedure laparoscopic adjustable gastric banding (LAGB) was introduced in the 1980s. Since then, it has been used in young obese women who wish to become pregnant and also to lower their risk of complications, even though there is not much data on its effects on maternal and fetal morbidity. This retrospective case-control study enrolled 427 obese women whose prepregnancy body mass index (BMI) was 30 or greater. Thirteen of these women underwent LABG. The interval from LAGB to conception averaged 17 months, and these women lost a mean of 24 kg body weight before becoming pregnant. Mean body weight and BMI at the outset of pregnancy were 95 kg and 34.8, respectively. The LAGB and control groups did not differ with regard to maternal age at the time of conception. Women in the LAGB group gained significantly less weight during pregnancy than did control women (5.5 vs. 7.1 kg). Incidence rates of preeclampsia, gestational diabetes, low birth weight, and fetal macrosomia all were less for women having LAGB than for obese control women. There were, however, no significant differences in rates of induced labor for obstetrical complications or the use of epidural anesthesia. Overall, cesarean deliveries were significantly more frequent in control women than in study cases (34.4% vs. 15.3%). However, this difference was largely due to an increased number of prelabor cesareans in the control group; the rate of cesareans during labor was not different between the groups. The investigators believe that the increased number of prelabor cesareans in the control women was due to higher rates of preeclampsia, gestational diabetes, and low birth weight in this group. Among women having a previous cesarean delivery, the chance of requiring a repeat cesarean was significantly less in the study group. There was no significant group difference in mean birth weight, but low birth weight and macrosomia both were significantly more frequent in control women. Preterm births, 5-minute Apgar scores, and umbilical arterial blood gas values were comparable in the study and control groups. It appears that LAGB lowers the risk of adverse obstetrical complications in obese women. It is a safe procedure and is well tolerated by pregnant women.