Associations of Pregnancy After Bariatric Surgery with Long-Term Weight Trajectories and Birth Weight: LABS-2 Study

Impact of Pregnancy on Weight Loss After Endoscopic Sleeve Gastroplasty

PURPOSE

Obesity and pregnancy are strictly related: on the one hand, obesity-one of the most common comorbidities in women of reproductive age-contributes to infertility and obesity-related pregnancy complications, whereas pregnancy is a condition in which, physiologically, the pregnant woman undergoes weight gain. Endoscopic sleeve gastroplasty (ESG) may be used for the treatment of obesity in women of childbearing age.

MATERIALS AND METHODS

A retrospective analysis was conducted to evaluate weight trajectories, the evolution of obesity-related comorbidities, and lifestyle modification in women who became pregnant after ESG. A comparison was made between childbearing-age women who became pregnant after ESG and non-pregnant women.

RESULTS

A total of 150 childbearing-age women underwent ESG at a large tertiary medical center. Of these, 11 patients (33.4 ± 6.2 years) became pregnant after the procedure, following a mean time interval of 5.5 ± 3.9 months. Three women (two affected by polycystic ovary syndrome) reported difficulty getting pregnant before undergoing ESG. The mean preconception BMI was 31.9±4.0 kg/m2 (-7.24 ± 4.0 kg/m2 after ESG). Total body weight loss (TBWL, %) was 18.08 ± 8.00, 11.00 ± 11.08, and 12.08 ± 8.49, at the beginning of pregnancy, at the delivery, and at the first follow-up (19.6 ± 7.8 months after ESG). TBWL of at least 5% was achieved before pregnancy in all patients (73% reached a TBWL ≥ 10%). No significant differences in weight loss and QoL were found between the pregnancy and non-pregnancy groups up to 24 months after ESG.

CONCLUSIONS

Endoscopic sleeve gastroplasty allows for adequate weight loss before and after pregnancy in patients with obesity.

The Influence of Pregnancy on Weight Loss After Previous Bariatric Surgery

Introduction: Bariatric surgery is routinely performed on obese women of reproductive age, most commonly with the laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass procedures (RYGB). This study analyzes the effects of postoperative pregnancy on excess BMI loss percentage (EBMIL%) after SG and RYGB. Methods: A retrospective study was conducted with 191 female patients of reproductive age between 20 and 40 years who underwent SG and RYGB performed at our institution between January 2017 and December 2018. A comparison of the results at 4-year follow-up was performed between patients who became pregnant after bariatric surgery with patients who did not. Results: Among 191 total cases, 32 (16.7%) patients became pregnant within a 4-year follow-up period, and 159 (83.2%) patients did not. The median postoperative body mass index (BMI) in the pregnant group was 33.3 kg/m2 (interquartile range [IQR] 30.1-38.5) and 33.5 kg/m2 (IQR 28.9-38.6) in the nonpregnant group. The mean EBMIL% within a 4-year follow-up in the pregnant group was 50.4% (standard deviation [SD] 23.5) and 55.5% (SD 30.4) in the nonpregnant group. The median weight before surgery in the pregnant group was 112 kg (IQR 107.9-132.2) and 117 kg (IQR 106-132.5) in the nonpregnant group. The median weight after surgery in the pregnant group was 89.5 kg (IQR 79.5-111) and 88.9 kg (IQR 78-103) in the nonpregnant group. There was no significant difference between outcomes. Conclusion: Weight loss maintenance after bariatric surgery is not impacted by postoperative pregnancy within a 4-year follow-up after SG and RYGB.

Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review

PURPOSE

Bariatric surgery increases the risk of lower birth weight, small-for-gestational-age (SGA) infants, and preterm birth in a subsequent pregnancy. However, the factors that contribute to these adverse birth outcomes are unclear. This review aimed to collate available information about risk factors of lower birth weight, SGA, and preterm birth following bariatric surgery.

METHODS

A literature search was conducted using five databases (PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library) to obtain relevant studies.

RESULTS

A total number of 85 studies were included. Studies generally excluded surgery-to-conception interval, pregnancy complications, cigarette use, and maternal age as influencing factors of birth weight, SGA, or preterm birth. In contrast, most studies found that malabsorptive procedures, lower gestational weight gain, lower glucose levels, abdominal pain, and insufficient prenatal care were associated with an elevated risk of adverse birth outcomes. Findings were mixed regarding the effects of surgery-to-conception weight loss, pre-pregnancy body mass index, micronutrient deficiency, and lipid levels on birth outcomes. The examination of maternal microbiome profiles, placental function, alcohol use, and exercise was limited to one study; therefore, no conclusions could be made.

CONCLUSION

This review identified factors that appear to be associated (e.g., surgery type) or not associated (e.g., surgery-to-conception interval) with birth outcomes following bariatric surgery. The mixed findings and the limited number of studies on several variables (e.g., micronutrients, exercise) highlight the need for further investigation. Additionally, future studies may benefit from exploring interactions among risk factors and expanding to assess additional exposures such as maternal mental health.

Reproductive outcomes after bariatric surgery in women

The presence of obesity may significantly influence female fertility through various mechanisms. Impairment of the hypothalamic-pituitary-ovarian axis in obese women may induce anovulation and infertility. Obesity may have an effect on women’s spontaneous and assisted conception rates, increased miscarriage rates, premature labor, stillbirth and perinatal risks, and menstrual irregularity. It has been suggested that weight loss improves reproductive outcomes due to fertility amelioration and an improvement in menstrual irregularity and ovulation. It is still not known which weight reduction procedures (changes in lifestyle, pharmacological management or bariatric intervention) result in optimal outcome on infertility. Currently, bariatric surgery is defined as the best available method for the management of obesity and its associated diseases.

We have analyzed literature facts about effects of bariatric surgery on the function of the hypothalamic-pituitary-ovarian axis, polycystic ovary syndrome (PCOS), anti-Mullerian hormone (AMH) and sexual dysfunction in obesity and pregnancy in obesity. Immediate positive effects of bariatric surgery are evident at the moment, while for long-term outcomes more prolonged follow-up investigations should be done.