Should severely obese women complete childbearing prior to undergoing bariatric surgery?

Abstract

GOING BARIATRIC SURGERY? ELLEN LANDSBERGER, YVONNE ANKRAH, CJ SEGAL-ISAACSON, EDITH GUREWITSCH, LISA LEVINE, FRANCINE EINSTEIN, CYNTHIA CHAZOTTE, Albert Einstein College of Medicine, Obstetrics & Gynecology and Women’s Health, Bronx, New York, Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, New York, Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland OBJECTIVE: Gastric bypass surgery (GBP) has become increasingly popular to treat severe obesity. 80% of patients having GBP are women. This study compares pregnancy outcomes of severely obese women who have undergone GBP with similar patients matched to their preoperative and postoperative body mass index (BMI). STUDY DESIGN: A retrospective comparison study utilizing 3 groups of 19 patients each: Group 1=patients who had GBP, Group 2=1 patients matched to preoperative BMI, Group 3=patients matched to postoperative BMI. Patients delivered from 2004-2006. Data were analyzed utilizing Chi-Square and analysis of variance. RESULTS: Even with significant weight loss, most GBP patients remained obese. Mean BMI=37.1 (SDG7.7), mean BMI of Group 2=47.6 (G7.3), mean BMI group 3=36.4 (G7.1) There were no significant differences in the pregnancy outcomes among the three groups. There was a trend toward preeclampsia in the GBP group (p=.051); but no difference in chronic hypertension. Although the pre-op BMI group 2 had the heaviest babies (3454G764gms), the mean birthweights were similar (GBP=3002G609gms, Grp 3=3093G590gms); the incidence of IUGR and macrosomia was not different. Although there was not a significant difference in gestational diabetes (GDM) alone, the incidence of GDM and pregestational diabetes was lower in the GBP group (3/19,15.8%) than in group 2 (8/19,42.1%) or group 3 (4/ 19,21.1%). There was 1 second trimester loss in the GBP and group 2. There were no differences in mode of delivery, preterm delivery, anemia, or perinatal complications among the groups. CONCLUSION: Many women who have had GBP remain obese despite significant weight loss. Although significant differences in pregnancy outcomes were not observed, the higher rate of preeclampsia in the GBP group deserves further study. Our data suggest that GBP may safely be performed in women prior to completion of childbearing.