Page 107 - Read Online

Page 2 of 12 Young et al. Mini-invasive Surg 2018;2:16 I http://dx.doi.org/10.20517/2574-1225.2017.50

Conclusion: Patients affected by obesity considering conceiving in the near future should consider bariatric surgery prior
to conception to lower their risk of potentially adverse delivery outcomes.

Keywords: Bariatric, pregnancy, neonatal, maternal

INTRODUCTION
Currently in the United States, more than two-thirds of the adult population is overweight and one-third
are obese . The most widely accepted measure used to define obesity is a body mass index [BMI; weight
[1,2]
(kg)/height (m )] of more than 30 kg/m , as recommended by the National Heart, Lung and Blood Institute’s
2
2
North American Association for the Study of Obesity .
[3]
In general, being obese carries increased health risks for the individual. Serious health consequences
associated with obesity include type 2 diabetes, osteoarthritis, heart disease, stroke, and certain cancers .
[4]
More specifically, obesity in women of childbearing age is associated with subfertility/infertility due to
increased rates of anovulation . Pregnancy associated complication rates are also increased in obese
[5,6]
women, including gestational diabetes, preeclampsia, cesarean delivery, and infectious morbidity .
[5,7]
The neonate of a mother who is obese is also at increased risk for complications. While studies have not found
higher incidence of spontaneous preterm labor, there are increased rates of preterm delivery for maternal
or fetal indications . In addition, studies have found an increase in macrosomic and large for gestational
[8]
age (LGA) infants among mothers who are obese . Finally, there are multiple congenital obesity-related
[9]
abnormalities such as neural tube defects, cardiac anomalies and facial clefting as well as increased risks
with miscarriage and stillbirth .
[9]
Weight loss outside of pregnancy, whether achieved via surgical or nonsurgical methods, has been shown to
be the most effective intervention to improve medical comorbidities, especially diabetes and hypertension.
Nonsurgical approaches to weight loss include diet, exercise, behavioral changes, and pharmacotherapy.
However, bariatric surgery has been found to be both a clinically and cost-effective intervention for people
affected by obesity as compared to the nonsurgical approaches . There are several bariatric procedures
[4]
available to qualifying patients, with the four most common being: adjustable gastric band, laparoscopic
sleeve gastrectomy, gastric bypass, and biliopancreatic diversion with duodenal switch.

While there have been several studies on the effects of obesity on maternal and fetal outcomes, there have
only been a few systematic reviews looking at these outcomes in patients that have undergone bariatric
surgery [10-12] . However, multiple papers have been published in the last few years to further explore the topic.
Our goal in this systematic review is to compare maternal and neonatal outcomes in patients who are obese
that have undergone bariatric surgery and those that have not.

METHODS
A systematic review was conducted through MEDLINE, Cochrane, and EMBASE to identify relevant studies
from 2007 to 2016 with comparative data on the maternal and fetal delivery outcomes following bariatric
surgery as compared to the population affected by obesity. The following terms were searched: pregnancy
outcomes AND bariatric surgery, neonatal outcomes AND bariatric surgery, maternal outcomes AND
bariatric surgery, delivery outcomes AND bariatric surgery and perinatal outcomes AND bariatric surgery.
The following outcomes were recorded: (1) the primary outcome was rate of cesarean delivery; (2) the secondary
outcomes included small for gestational age (SGA) or < 10% of birthweight as compared to infants of same
gestational age, LGA or > 90% of birthweight as compared to infants of same gestational age, macrosomia
(> 4000 g at birth), assisted vaginal delivery, and preterm delivery (< 37 weeks gestational age at delivery).