Women who get pregnant after having weight-loss surgery have a lower risk of maternal and newborn complications than pregnant women who are obese, according to U.S. researchers who analyzed 75 studies.
Data from those studies showed that bariatric surgery in the United States increased by 800 percent between 1998 and 2005 (from 12,480 to 113,500). Women accounted for 83 percent of procedures among patients ages 18 to 45. Between 2003 and 2005, more than 50,000 women in this age group had inpatient bariatric surgery each year, which accounted for 49 percent of all bariatric surgeries.
The review authors found that pregnant women who’d had bariatric surgery had lower maternal complication rates than obese women, including gestational diabetes (0 percent vs. 22.1 percent) and preeclampsia (0 percent vs. 3.1 percent). In addition, maternal weight gain was reduced in women who’d had bariatric surgery.
Newborn outcomes among women who’d had laparoscopic adjustable band surgery were similar or better than outcomes among obese women: premature delivery, 7.7 percent vs. 7.1 percent; low birth weight, 7.7 percent vs. 10.6 percent; overly large body (macrosomia), 7.7 percent vs. 14.6 percent.
The findings were published in the Nov. 19 issue of the Journal of the American Medical Association.
“Research is needed to better delineate the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes,” the review authors wrote. “Optimizing success for contraception and producing healthy neonates following surgery will require a multidisciplinary effort by surgeons, primary care physicians, reproductive fertility specialists, obstetricians, and patients.”
Having bariatric surgery during childbearing years may change a woman’s fertility following weight loss, alter nutritional requirements during pregnancy, or impact contraception, the researchers noted.
Complications of Bariatric surgery:
Early complications of these operations can include bleeding, infection, leaks from the site where the intestines are sewn together, and blood clots in the legs that can progress to the lungs and heart.
Examples of complications that may occur later include malnutrition, especially in patients who do not take their prescribed vitamins and minerals. In some cases, if the malnutrition is not addressed promptly, diseases such as pellagra, beri beri, and kwashiorkor may occur along with permanent damage to the nervous system. Other late complications include strictures (narrowing of the sites where the intestine is joined) and hernias.
Two kinds of hernias may occur after a patient has bariatric surgery. An incisional hernia is a weakness that sticks out from the abdominal wall’s fascia (connective tissue) and may cause a blockage in the bowel. An internal hernia occurs when the small bowel is displaced into pockets in the lining of the abdomen. These pockets are created when the intestines are sewn together. Internal hernias are considered more dangerous than incisional ones and need prompt attention to avoid serious complications.
Research indicates that about 10 percent of patients who undergo bariatric surgery may have unsatisfactory weight loss or regain much of the weight that they lost. Some behaviors such as frequent snacking on high-calorie foods or lack of exercise can contribute to inadequate weight loss. Technical problems that may occur with the operation, like a stretched pouch or separated stitches, may also contribute to inadequate weight loss.
Some patients may also require emotional support to help them through the postoperative changes in body image and personal relationships.
Bariatric surgery may be the next step for people who remain severely obese after trying nonsurgical approaches, especially if they have an obesity-related disease. Surgery to produce weight loss is a serious undertaking. Anyone thinking about undergoing this type of operation should understand what it involves. Answers to the following questions may help you decide whether weight-loss surgery is right for you.
Is surgery for you?
– Unlikely to lose weight or keep it off over the long-term with nonsurgical measures?
– Well informed about the surgical procedure and the effects of treatment?
-Determined to lose weight and improve your health?
– Aware of how your life may change after the operation (adjustment to the side effects of the operation, including the need to chew food well and inability to eat large meals)?
– Aware of the potential risk for serious complications, dietary restrictions, and occasional failures?
– Committed to lifelong healthy eating and physical activity habits, medical follow-up, and vitamin/mineral supplementation?
Remember: There are no guarantees for any method, including surgery, to produce and maintain weight loss. Success is possible only with maximum cooperation and commitment to behavioral change and medical follow-up—and this cooperation and commitment must be carried out for the rest of your life.