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Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks?
Am J Obstet Gynecol. 2018 06; 218(6):573-580.AJ

Abstract

OBJECTIVE DATA

Obesity during pregnancy is associated with a number of adverse obstetric outcomes that include gestational diabetes mellitus, macrosomia, and preeclampsia. Increasing evidence shows that bariatric surgery may decrease the risk of these outcomes. Our aim was to evaluate the benefits and risks of bariatric surgery in obese women according to obstetric outcomes.

STUDY

We performed a systematic literature search using MEDLINE, Embase, Cochrane, Web of Science, and PubMed from inception up to December 12, 2016. Studies were included if they evaluated patients who underwent bariatric surgery, reported subsequent pregnancy outcomes, and compared these outcomes with a control group.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two reviewers extracted study outcomes independently, and risk of bias was assessed with the use of the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratios for each outcome were estimated with the Dersimonian and Laird random effects model.

RESULTS

After a review of 2616 abstracts, 20 cohort studies and approximately 2.8 million subjects (8364 of whom had bariatric surgery) were included in the metaanalysis. In our primary analysis, patients who underwent bariatric surgery showed reduced rates of gestational diabetes mellitus (odds ratio, 0.20; 95% confidence interval, 0.11-0.37, number needed to benefit, 5), large-for-gestational-age infants (odds ratio, 0.31; 95% confidence interval, 0.17-0.59; number needed to benefit, 6), gestational hypertension (odds ratio, 0.38; 95% confidence interval, 0.19-0.76; number needed to benefit, 11), all hypertensive disorders (odds ratio, 0.38; 95% confidence interval, 0.27-0.53; number needed to benefit, 8), postpartum hemorrhage (odds ratio, 0.32; 95% confidence interval, 0.08-1.37; number needed to benefit, 21), and caesarean delivery rates (odds ratio, 0.50; 95% confidence interval, 0.38-0.67; number needed to benefit, 9); however, group of patients showed an increase in small-for-gestational-age infants (odds ratio, 2.16; 95% confidence interval, 1.34-3.48; number needed to harm, 21), intrauterine growth restriction (odds ratio, 2.16; 95% confidence interval, 1.34-3.48; number needed to harm, 66), and preterm deliveries (odds ratio, 1.35; 95% confidence interval, 1.02-1.79; number needed to harm, 35) when compared with control subjects who were matched for presurgery body mass index. There were no differences in rates of preeclampsia, neonatal intensive care unit admissions, stillbirths, malformations, and neonatal death. Malabsorptive surgeries resulted in a greater increase in small-for-gestational-age infants (P=.0466) and a greater decrease in large-for-gestational-age infants (P=<.0001) compared with restrictive surgeries. There were no differences in outcomes when we used administrative databases vs clinical charts.

CONCLUSION

Although bariatric surgery is associated with a reduction in the risk of several adverse obstetric outcomes, there is a potential for an increased risk of other important outcomes that should be considered when bariatric surgery is discussed with reproductive-age women.

Authors+Show Affiliations

Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Mount Sinai Hospital, Toronto, Ontario, Canada.Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism and the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: Denice.Feig@sinaihealthsystem.ca.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

29454871

Citation

Kwong, Wilson, et al. "Maternal and Neonatal Outcomes After Bariatric Surgery; a Systematic Review and Meta-analysis: Do the Benefits Outweigh the Risks?" American Journal of Obstetrics and Gynecology, vol. 218, no. 6, 2018, pp. 573-580.
Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018;218(6):573-580.
Kwong, W., Tomlinson, G., & Feig, D. S. (2018). Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? American Journal of Obstetrics and Gynecology, 218(6), 573-580. https://doi.org/10.1016/j.ajog.2018.02.003
Kwong W, Tomlinson G, Feig DS. Maternal and Neonatal Outcomes After Bariatric Surgery; a Systematic Review and Meta-analysis: Do the Benefits Outweigh the Risks. Am J Obstet Gynecol. 2018;218(6):573-580. PubMed PMID: 29454871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? AU - Kwong,Wilson, AU - Tomlinson,George, AU - Feig,Denice S, Y1 - 2018/02/15/ PY - 2017/08/30/received PY - 2018/01/05/revised PY - 2018/02/08/accepted PY - 2018/2/20/pubmed PY - 2019/5/21/medline PY - 2018/2/19/entrez KW - bariatric surgery KW - gestational diabetes mellitus KW - obstetric outcome KW - pregnancy outcome SP - 573 EP - 580 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 218 IS - 6 N2 - OBJECTIVE DATA: Obesity during pregnancy is associated with a number of adverse obstetric outcomes that include gestational diabetes mellitus, macrosomia, and preeclampsia. Increasing evidence shows that bariatric surgery may decrease the risk of these outcomes. Our aim was to evaluate the benefits and risks of bariatric surgery in obese women according to obstetric outcomes. STUDY: We performed a systematic literature search using MEDLINE, Embase, Cochrane, Web of Science, and PubMed from inception up to December 12, 2016. Studies were included if they evaluated patients who underwent bariatric surgery, reported subsequent pregnancy outcomes, and compared these outcomes with a control group. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers extracted study outcomes independently, and risk of bias was assessed with the use of the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratios for each outcome were estimated with the Dersimonian and Laird random effects model. RESULTS: After a review of 2616 abstracts, 20 cohort studies and approximately 2.8 million subjects (8364 of whom had bariatric surgery) were included in the metaanalysis. In our primary analysis, patients who underwent bariatric surgery showed reduced rates of gestational diabetes mellitus (odds ratio, 0.20; 95% confidence interval, 0.11-0.37, number needed to benefit, 5), large-for-gestational-age infants (odds ratio, 0.31; 95% confidence interval, 0.17-0.59; number needed to benefit, 6), gestational hypertension (odds ratio, 0.38; 95% confidence interval, 0.19-0.76; number needed to benefit, 11), all hypertensive disorders (odds ratio, 0.38; 95% confidence interval, 0.27-0.53; number needed to benefit, 8), postpartum hemorrhage (odds ratio, 0.32; 95% confidence interval, 0.08-1.37; number needed to benefit, 21), and caesarean delivery rates (odds ratio, 0.50; 95% confidence interval, 0.38-0.67; number needed to benefit, 9); however, group of patients showed an increase in small-for-gestational-age infants (odds ratio, 2.16; 95% confidence interval, 1.34-3.48; number needed to harm, 21), intrauterine growth restriction (odds ratio, 2.16; 95% confidence interval, 1.34-3.48; number needed to harm, 66), and preterm deliveries (odds ratio, 1.35; 95% confidence interval, 1.02-1.79; number needed to harm, 35) when compared with control subjects who were matched for presurgery body mass index. There were no differences in rates of preeclampsia, neonatal intensive care unit admissions, stillbirths, malformations, and neonatal death. Malabsorptive surgeries resulted in a greater increase in small-for-gestational-age infants (P=.0466) and a greater decrease in large-for-gestational-age infants (P=<.0001) compared with restrictive surgeries. There were no differences in outcomes when we used administrative databases vs clinical charts. CONCLUSION: Although bariatric surgery is associated with a reduction in the risk of several adverse obstetric outcomes, there is a potential for an increased risk of other important outcomes that should be considered when bariatric surgery is discussed with reproductive-age women. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/29454871/Maternal_and_neonatal_outcomes_after_bariatric_surgery L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(18)30146-7 DB - PRIME DP - Unbound Medicine ER -