Pregnancy after Bariatric Surgery: A Nested Case-Control Study of Risk Factors for Small for Gestational Age Babies in AURORA.

Zainab Akhter,Judith Rankin,Dries Ceulemans,Roland Devlieger,Nicola Heslehurst,Roger Ackroyd

doi:10.3390/nu13051699

Abstract

Bariatric surgery prior to pregnancy is a significant risk factor for small for gestational age (SGA) babies. This case-control study investigated differences between mothers delivering an SGA baby following bariatric surgery, compared to those delivering an appropriate for gestational age (AGA) baby. Out of 129 babies born to mothers in the AURORA cohort study, 25 were SGA (<10th percentile) and 97 were AGA (10th–90th percentile). Higher gestational weight gain (GWG) was significantly associated with decreased odds of SGA (aOR per kg 0.92, 95% CI 0.85–0.99). According to the Institute of Medicine GWG guidelines, 44% of SGA mothers had ‘inadequate’ GWG compared to 17% of AGA mothers. Nearly half of the mothers had ‘excessive’ GWG yet still gave birth to an SGA or AGA baby. Mothers of SGA babies lost more weight following bariatric surgery (45.6 ± 14.4 kg vs. 39.0 ± 17.9 kg). Women who reported receiving nutritional advice following bariatric surgery were significantly less likely to have an SGA baby (aOR 0.15, 95% CI 0.0.4–0.55). Women with a history of bariatric surgery should be provided with specialized support before and during pregnancy to encourage adequate nutritional intake and weight gain to support healthy fetal growth.

Highlights

Obesity is the most prevalent medical condition affecting women’s reproductive health today
Women with a history of bariatric surgery should be provided with specialized support before and during pregnancy to encourage adequate nutritional intake and weight gain to support healthy fetal growth
This study showed that exercise during pregnancy may decrease the chances of having an small for gestational age (SGA) baby after bariatric surgery, which is in line with previous research demonstrating that increased physical activity improves placental vascularity and function, and subsequently nutrient and oxygen transfer, and that mothers that exercise during pregnancy are more likely to have an appropriate for gestational age (AGA) baby than either SGA or large for gestational age (LGA) babies [29,30,31]

Summary

Introduction

Obesity is the most prevalent medical condition affecting women’s reproductive health today. 30 kg/m2 and is associated with a range of severe health complications for both mother and baby [1,2,3]. Bariatric surgery is the most effective treatment for long-term weight loss, and the majority of patients are women of reproductive age [4]. Undergoing bariatric surgery prior to pregnancy significantly reduces the risk of obesity-related comorbidities such as gestational diabetes, hypertension, and infertility [5,6]. Bariatric surgery prior to pregnancy has been linked to maternal nutrient deficiencies and small for gestational age (SGA) babies [7]. Procedures which reduce the absorption of micronutrients such as gastric bypass surgery are associated with over twice the odds of having an SGA baby compared to the general obstetric population [8]

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