One size does not fit all. Management of the laparoscopic adjustable gastric band in pregnancy: a national prospective cohort study

Abstract

BackgroundPregnancies are increasingly seen in women with a gastric band, but no guidance exists on band management during pregnancy. Although band inflation can prevent excessive gestational weight gain and its associated complications, it might have detrimental effects on fetal growth. We compared maternal and perinatal outcomes according to band management strategy—keeping the band inflated throughout pregnancy versus deflation. MethodsData were collected by means of the UK Obstetric Surveillance System (UKOSS) on all pregnancies in women with a laparoscopic adjustable gastric band, booking in UK maternity units (Nov 1, 2011, to Oct 31, 2012). Maternal and perinatal outcomes were compared according to band management strategy, with women in a control group who had not undergone the procedure and with national data. Multivariable regression analyses were used to adjust for potential confounders. Findings109 cases were reported (prevalence 1·7 per 10 000 maternities), of whom 42 underwent band deflation and 54 had inflation maintained (remainder unknown). Mean weight gain was higher with deflation than inflation (15·4 kg [95% CI 10·8–20·0] vs 7·6 [3·7–11·5], p=0·047). Some evidence of a higher risk of gestational hypertension with deflation than with inflation was noted (relative risk [RR] 6·86, p=0·07). There was strong evidence of a high risk of gestational hypertension with deflation compared with controls and national data (RR 4·74, p=0·001). Mean birth weight was significantly lower in the inflation group than in the deflation group (3380 g [95% CI 3255–3505] vs 3712 [3572–3851], p=0·002). Infants of women with deflation had a high risk of macrosomia compared with controls (adjusted RR 0·40, p=0·002) and national data (RR 2·04, p=0·01). InterpretationPregnant women with a laparoscopic adjustable gastric band are high risk; the monitoring of both fetal and maternal wellbeing is essential. Maintainance of band inflation during pregnancy reduces gestational weight gain and associated complications, but affects fetal growth. Therefore, maintainance of band inflation throughout pregnancy cannot be recommended. However, inflation for part of the pregnancy might improve some maternal outcomes. Further studies are needed to define the optimum timing of band adjustment. FundingBristol Bariatric Pregnancy Research Hub.