Page 115 - Read Online

Page 10 of 12 Young et al. Mini-invasive Surg 2018;2:16 I http://dx.doi.org/10.20517/2574-1225.2017.50

SGA
The 6 studies included in this section found either no difference or an increased risk of SGA neonates among
bariatric surgery patients [13,15,19-21,23] while our data suggests an increased risk of SGA among the bariatric surgery
woman as compared to the controls. However, this is potentially due to the same reasons as listed above for IUGR.

Of the six studies reviewed, only two specified the banding procedure for their surgical subjects [13,19] . A sub
analysis of this data showed no difference in the surgical patient versus the control when banding is performed,
thus giving us indeterminate results for this category. Further studies would need to be to determine the SGA
rates in bypass versus banding patients.

LGA and macrosomia
A total of 5 studies included data on LGA [13,15,20-22] and 8 studies included data on macrosomia rates [13-17,19,20,23] .
While there were a few select papers that showed no difference, the majority of the studies reviewed showed
a significant decrease in the rates of both LGA and macrosomic neonates in the bariatric surgery patient.
Women who gain less weight during the pregnancy, on average, have a decreased chance of delivering a LGA
or macrosomic neonate .
[15]
Our analysis found there was a decreased incidence of both LGA and macrosomia in the bariatric surgical
women who are obese, as compared to the obese controls. We conclude that bariatric surgery lowers the rates
of LGA and macrosomic neonates.

Assisted delivery
The majority of the 7 papers included in this section showed no difference for bariatric surgery patients [14,17-19,22-24] .
However, when we ran the data combined we found a decreased rate in assisted delivery as compared to the
obese control group. This is likely due to a decrease in the size of the neonate in the bariatric surgery patient.

Premature delivery
None of the 9 studies included showed a difference in the rates of premature delivery of the neonate [13,14,16,19-21,23-25]
and our data supports this conclusion. We did not find any significant difference in the bariatric surgery
patient and thus cannot associate surgery to the incidence of early delivery rates.

Strengths and weaknesses
This is the most recent systematic review on the subject of bariatric surgery and maternal and neonatal
outcomes. This was done on a large data size including a total of 439,561 subjects. We used a total of 13
studies in order to give a comprehensive and unbiased review of the current material. Time between surgery
and pregnancy was not able to be included as only four of the articles included this variable. In the future,
the inclusion of miscarriage rates associated with bariatric surgery and a more extensive review of maternal
complications compared with time between surgery and pregnancy would further evaluate the fetal and
maternal outcomes in post-bariatric surgical patients.

However, there are always limitations to every review. We only included papers that were published in
English or were able to be translated into English. In addition, not all of the studies separated the various
types of surgery so we could only review bariatric surgery as a whole. Finally, while we used the BMI range
of “obese” there was some variation in the obese range between the controls and bariatric surgery patients.

DECLARATIONS
Authors’ contributions
Primary author: Young B
Secondary author: Drew S