Women should wait at least 12 months before trying for a baby following weight loss surgery and need further advice and information on reproductive issues, suggests a new evidence-based literature review published today in The Obstetrician & Gynaecologist (TOG).
The review looks at the safety, advantages and limitations of bariatric surgery and multidisciplinary management of patients before, during and after pregnancy.
With the prevalence of obesity among women of reproductive age expected to rise from 24.2% in 2005 to 28.3% in 2015, the number of women undergoing bariatric surgery is increasing.
Obesity increases the risk of obstetric complications, however, pregnancy after bariatric surgery is safer than pregnancy in morbidly obese women, states the review. A previous study following pregnancies after weight loss surgery concluded that pregnancy is safe with 79.2% of participants having no complications during their pregnancy.
However, there can be surgical complications during pregnancy following bariatric surgery. A previous study found that band slippage and migration can occur, resulting in severe vomiting, and band leakage was reported in 24% of pregnancies.
Furthermore, based on the current evidence available, the authors of the review recommend that patients should not get pregnant for at least 12 months following bariatric surgery. One study found a higher spontaneous miscarriage rate among pregnancies occurring within 18 months of having weight loss surgery compared with those pregnancies occurring more than 18 months after surgery (31% versus 18%).
The review also recommends that women should receive advice and information pre-conception on topics such as contraception, nutrition and weight gain and vitamin supplementation.
Optimising success for a healthy maternal and neonatal outcome requires a multidisciplinary team including obstetricians, surgeons, primary care clinicians, anaesthetists, fertility specialists, nutritionists, psychologists and plastic surgeons as well as patients themselves, before, during and after pregnancy following weight loss surgery, concludes the review.
Rahat Khan, Consultant Obstetrician and Gynaecologist, Princess Alexandra Hospital NHS Trust, Harlow and co- author of the review said:
"An increasing number of women of child-bearing age are undergoing bariatric surgery procedures and need information and guidance regarding reproductive issues. In light of current evidence available, pregnancy after bariatric surgery is safer, with fewer complications, than pregnancy in morbidly obese women. Multidisciplinary input care is the key to a healthy pregnancy for women who have undergone bariatric surgery. However, this group of women should still be considered high risk by both obstetricians and surgeons.
"Increasingly, obstetricians, surgeons and primary care clinicians will be required to address questions posed by their patients regarding the safety of pregnancy after weight loss surgery."
TOG's Editor-in-Chief, Jason Waugh said:
"Pregnancy after bariatric surgery is safer than pregnancy in morbidly obese women. Women who have had bariatric surgery generally tolerate pregnancy well. However, there are risks involved and patients must be well informed.
"Optimal education should be encouraged in these individuals so that they can make well informed decisions about planning pregnancy after their surgery."
More information: Khan R, Bashir D, Chappatte O. Pregnancy outcome following bariatric surgery, The Obstetrician & Gynaecologist 2013;15:37–43