W200 DOES BARIATRIC SURGERY AFFECT FERTILITY AND SUBSEQUENT PREGNANCY OUTCOME?

Abstract

Objectives: Provided that the prevalence of obesity among women at reproductive age has increased dramatically over the last two decades, more and more morbidly obese patients undergo bariatric surgery, as the ultimate treatment for their obesity-problem. Since women of reproductive age are candidates for bariatric surgery, concerns arise regarding the potential impact on future fertility. The purpose of this study was to assess fertility and subsequent pregnancy outcomes, in women after bariatric surgery. Materials: Forty women with a history of previous bariatric surgery (BS) who delivered in our Hospital during a 10-year period, included in the study. Twenty six of them had undergone laparoscopically adjustable gastric band (LABG), while fourteen women had undergone Roux-en-Y gastric bypass (RYGB). Methods: Conception and live-births rates, as well as obstetric and neonatal outcomes were compared before and after BS. Results: Overall 44 pregnancies following spontaneous conceptions occurred in women with previous BS, that ended to 40 livebirths and 4 spontaneous 1st trimester abortions, compared to 20 pregnancies that occurred before the BS (P < 0.05) which ended to 8 live-births only and 12 spontaneous abortions (P < 0.05, respectively). The mean weight gain during pregnancy was significantly lower after the BS than before (10.3 kg vs. 25.9 kg; P < 0.05). Gestational diabetes mellitus, well controlled with diet, was diagnosed in 10 women. IUGR was identified in 8 cases. No cases of pre-eclampsia, fetal macrosomia, intrauterine fetal demise, placental abruption, placenta previa, labor dystocia, or perinatal complications were noted in women after BS. Two cases, that had undergone RYGB, developed illeus postoperatively; the first case developed obstructive illeus and surgical repair of intestinal hernia was performed, while the second one developed paralytic illeus which was conservatively managed. Women with LABG and RYGB had similar obstetric characteristics, pregnancy outcome and neonatal birth weights. Conclusions: BS significantly improved subsequent fertility and live birth rates. Rates of many adverse maternal and neonatal outcomes in women who become pregnant after having had bariatric surgery remain low as long as adequate maternal nutrition and vitamin supplementation are maintained. Close supervision before, during and after pregnancy following bariatric surgery can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population.