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Outcomes of pregnancy after bariatric surgery
Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, Sweden .
Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
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2015 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 372, no 9, 814-824 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS: We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother's presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS: Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P< 0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P< 0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P< 0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference -4.5 days; 95% CI, -2.9 to -6.0; P< 0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P = 0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P = 0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS: Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality.

Place, publisher, year, edition, pages
2015. Vol. 372, no 9, 814-824 p.
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:oru:diva-44010DOI: 10.1056/NEJMoa1405789ISI: 000349901700006PubMedID: 25714159Scopus ID: 2-s2.0-84923783851OAI: oai:DiVA.org:oru-44010DiVA: diva2:800184
Funder
Swedish Research Council
Available from: 2015-04-02 Created: 2015-04-02 Last updated: 2015-04-02Bibliographically approved

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CiteExportLink to record
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Citation style
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