[en] [en] BACKGROUND: Recommendations by the Institute of Medicine (IOM) on gestational weight gain (GWG) for women with histories of bariatric surgery have yet to be studied.
OBJECTIVES: To describe GWG in women with histories of bariatric surgery and to investigate the relationship between GWG and maternal and neonatal outcomes.
STUDY DESIGN: A bicentric retrospective study on the medical charts of pregnant women with histories of bariatric surgery who delivered between 2003 and 2017 in two level III maternity units. In accordance with IOM guidelines, GWG was classified as insufficient, adapted, or excessive.
RESULTS: At least 337 pregnancies from 264 patients were included in this study. Of these pregnancies, 154 (45.7%) occurred after gastric banding, 135 (40.1%) after Roux-en-Y gastric bypass, and 48 (14.2%) after sleeve gastrectomy. GWG was adapted in 90 of the pregnancies (26.7%), insufficient in 11 of the pregnancies (35%), and excessive in 129 of pregnancies (38.3%). Gestational age at birth was significantly lower when GWG was insufficient (37.7 ± 4.2 weeks vs. 38.8 ± 2.9 weeks for adequate GWG and 39.4 ± 1.8 weeks for excessive GWG). When compared to normal GWG, insufficient GWG was indicated to be a risk factor for preterm labor (adjusted OR, 3.05, 95% CI 1.30-7.17). When compared to excessive GWG, insufficient GWG increased the rates of small for gestational age (SGA) newborns (OR, 1.96, 95% CI 1.04-3.68), preterm labor (OR, 4.13, 95% CI 1.84-9.24), and preterm delivery (OR, 6.40, 95% CI 2.41-17.0).
CONCLUSION: In our study, adequate GWG was associated with better obstetrical outcomes, resulting in the conclusion that IOM recommendations applied to pregnant women who had undergone bariatric surgery. Our findings suggest that the large proportion of women with insufficient GWG may account for increased rates of SGA and preterm birth.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Grandfils, Sébastien ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique
Demondion, Delphine; Department of Obstetrics, Jeanne de Flandre Hospital, University Hospital of Lille, Lille 59000, France
Kyheng, Maéva; University of Lille, HospitalUniversity of Lille, EA2694 -Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
Duhamel, Alain; University of Lille, HospitalUniversity of Lille, EA2694 -Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
Lorio, Elodie; Department of Obstetrics, Regional Hospital of Valenciennes, Valenciennes 59300, France
Pattou, François; UMR 1190, Inserm-Faculty of Medicine, University of Lille, Lille 59000,France, Department of general and endocrine surgery, Huriez Hospital, University Hospital of Lille, Lille 59000, France
Deruelle, Philippe; Department of Obstetrics, Jeanne de Flandre Hospital, University Hospital of Lille, Lille 59000, France, EA 4489-Perinatal, Environment and health, Faculty of Medicine, University of Lille, Lille 59000, France
Language :
English
Title :
Impact of gestational weight gain on perinatal outcomes after a bariatric surgery.
Publication date :
June 2019
Journal title :
Journal of Gynecology Obstetrics and Human Reproduction
eISSN :
2468-7847
Publisher :
Elsevier Masson, Issy les Moulineaux Cedex, France
Gilbert, E.W., Wolfe, B.M., Bariatric surgery for the management of obesity: state of the field. Plast Reconstr Surg 130:4 (2012), 948–954.
Quyên Pham, T., Pigeyre, M., Caiazzo, R., Verkindt, H., Deruelle, P., Pattou, F., Does pregnancy influence long-term results of bariatric surgery?. Surg Obes Relat Dis 11:September–October(5)(2015), 1134–1139.
Aricha-Tamir, B., Weintraub, A.Y., Levi, I., Sheiner, E., Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery. Surg Obes Relat Dis 8:4 (2012), 434–439.
Johansson, K., Cnattingius, S., Näslund, I., et al. Outcomes of pregnancy after bariatric surgery. N Engl J of Med 372 (2015), 814–824.
Carreau, A.-M., Nadeau, M., Marceau, S., Marceau, P., Weisnagel, S.J., Pregnancy after bariatric Surgery: balancing risks and benefits. Can J Diabetes 4:41 (2017), 432–438.
Institute of Medicine (US)and National Research Council (US)Committee to Reexamine IOM Pregnancy Weight Guidelines, Weight gain during pregnancy: reexamining the guidelines. 2009, National Academies Press, Washington, DC Available at: http://www.ncbi.nlm.nih.gov/books/NBK32813/Accessed June 30, 2017.
Colquitt, J.L., Pickett, K., Loveman, E., Frampton, G.K., Surgery for weight loss in adults. Cochrane Database Syst Rev, 8(8), 2014 CD003641.
World Health Organization, Obesity: preventing and managing the global epidemic: report of a WHO consultation., 2000, World Health Organization, Geneva, 253.
World Health Organization, Obesity and overweight. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/. [Accessed 7 July 2017], 2017.
Dennedy, M.C., Dunne, F., The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome. Best Pract Res Clin Endocrinol Metab 24:4 (2010), 573–589.
Nuthalapaty, F.S., Rouse, D.J., The impact of obesity on obstetrical practice and outcome. Clin Obstet Gynecol 47:4 (2004), 898–913 discussion 980–981.
Faucher, M., Hastings-Tolsma, M., Song, J., Willoughby, D., Bader, S.G., Gestational weight gain and preterm birth in obese women: a systematic review and meta-analysis. BJOG Int J Obstet Gynaecol 123:2 (2016), 199–206.
Faucher, M.A., Barger, M.K., Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: a systematic review. Women Birth 28:3 (2015), e70–e79.
Dixon, J.B., Dixon, M.E., O'Brien, P.E., Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 106:5 Pt 1 (2005), 965–972.
Lapolla, A., Marangon, M., Dalfrà, M.G., et al. Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding. Obes Surg 20:9 (2010), 1251–1257.
Marceau, P., Kaufman, D., Biron, S., et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg 14:3 (2004), 318–324.
Ducarme, G., Revaux, A., Rodrigues, A., Aissaoui, F., Pharisien, I., Uzan, M., Obstetric outcome following laparoscopic adjustable gastric banding. Int J Gynecol Obstet Neonatal Care 98:3 (2007), 244–247.
Dias, M.C.G., Fazio, Ede S., de Oliveira, F.C.B.M., Nomura, R.M.Y., Faintuch, J., Zugaib, M., Body weight changes and outcome of pregnancy after gastroplasty for morbid obesity. Clin Nutr 28:2 (2009), 169–172.
Skull, A.J., Slater, G.H., Duncombe, J.E., Fielding, G.A., Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes. Obes Surg 14:2 (2004), 230–235.
Berglind, D., Willmer, M., Näslund, E., Tynelius, P., Sorensen, T.I.A., Rasmussen, F., Differences in gestational weight gain between pregnancies before and after maternal bariatric surgery correlate with differences in birth weight but not with scores on the body mass index in early childhood: bariatric surgery, GWG and offspring weight. Int J Pediatr Obes 9:6 (2014), 427–434.
Stentebjerg, L.L., Andersen, L.L.T., Renault, K., Stoving, R.K., Jensen, D.M., Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass. J Matern Fetal Neonatal Med 30:10 (2017), 1182–1188.
Ego, A., Prunet, C., Lebreton, E., et al. Courbes de croissance in utero ajustées et non ajustées adaptées à la population française. I — Méthodes de construction. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 45:2 (2016), 155–164.
Carelli, A.M., Ren, C.J., Youn, H.A., et al. Impact of laparoscopic adjustable gastric banding on pregnancy, maternal weight, and neonatal health. Obes Surg 21:10 (2011), 1552–1558.
Chagas, C., Saunders, C., Pereira, S., Silva, J., Saboya, C., Ramalho, A., Perinatal outcomes and the influence of maternal characteristics after Roux-en-Y gastric bypass surgery. J Womens Health 26:1 (2017), 71–75.
Lindberg, S., Anderson, C., Pillai, P., Tandias, A., Arndt, B., Hanrahan, L., Prevalence and predictors of unhealthy weight gain in pregnancy. WMJ 115:5 (2016), 233–237.
Roos, N., Neovius, M., Cnattingius, S., et al. Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study. BMJ, 347, 2013, f6460.
Wen, T., Lv, Y., Inadequate gestational weight gain and adverse pregnancy outcomes among normal weight women in China. Int J Clin Exp Med 8:2 (2015), 2881–2886.
Catalano, P.M., Mele, L., Landon, M.B., et al. Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth?. Am J Obstet Gynecol, 211(2), 2014, 137 e1–7.
Oken, E., Taveras, E.M., Kleinman, K.P., Rich-Edwards, J.W., Gillman, M.W., Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol, 196(4), 2007, 322 e1-8.
Coupaye, M., Legardeur, H., Sami, O., et al. Impact of Roux-en-Y gastric bypass and sleeve gastrectomy on fetal growth and relationship with maternal nutritional status. Surg Obes Relat Dis 14:10 (2018), 1488–1494.
