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Young et al. Mini-invasive Surg 2018;2:16 I http://dx.doi.org/10.20517/2574-1225.2017.50 Page 3 of 12

Records identified through
Identification database searching

(n = 1406)

Records after duplicates removed
(n = 549)
Screening

Records screened

(n = 521)
(n = 549) Records excluded
Full-text articles
Full-text articles assessed excluded, with reasons:

for eligibility
Eligibility (n = 28) -Not relevant (n = 1)
-No controls (n = 4)

Studies included in

qualitative synthesis
(n = 14)
Included Studies included in

quantitative synthesis
(meta-analysis)
(n = 13)

Figure 1. PRISMA flow diagram

Cohort studies that reported on fetal and/or maternal outcomes in terms of the comparison of women who
are obese that underwent bariatric surgery to women affected by obesity who did not have bariatric surgery
were included with obese being defined as a BMI ≥ 30. For our purposes, bariatric surgery included any
weight loss surgery. Papers selected were published in English or able to be translated into English. Papers
were also selected based on the ability to directly compare data as presented. Studies were excluded if they
did not have a control population or included non-obese women in the study.

The Newcastle-Ottawa scale was used by two assessors to evaluate the quality of the studies based on
selection, comparability and outcome. Only studies found to have a 9 or greater points (from a maximum of
10 points) were selected for analysis [Figure 1].

The results are expressed as standard difference in means with standard error. Statistical analysis was done
using fixed-effects meta-analysis to compare the mean value of the two groups (Comprehensive Meta-
Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).

RESULTS
Search results
The electronic search from 2007 to 2016 yielded a total of 549 individual titles, of which 28 were found to be
potentially relevant based on abstract. After a full text review of the 28 studies, a total of 13 were determined
by the Newcastle-Ottawa scale to be relevant [13-25] .