Obstetric outcomes after restrictive bariatric surgery: What happens after 2 consecutive pregnancies?

Background: The objective of this study was to compare the outcomes of 2 consecutive pregnancies of the same women who conceived after restrictive bariatric surgeries. Methods: A retrospective study comparing consecutive pregnancy outcomes of the same women, who conceived before and twice after a restrictive bariatric surgery, was conducted. Results: This study included 109 women, and therefore, 327 paired pregnancies: 109 pregnancies preceded and 218 followed restrictive bariatric surgery (87% had laparoscopic banding, and 13% had silastic ring vertical gastroplasty). Both prepregnancy and predelivery body mass index were significantly lower after bariatric surgery (36.7 +/- 4.4 versus 31. 5 +/- 5.5, P < .001; 40.6 +/- 5.5 versus 35.3 +/- 6.1, P < .001; respectively). This effect was preserved at the subsequent pregnancy (31.5 +/- 5.5 versus 31.3 +/- 6.3, P = .609, and 35.3 +/- 6.1 versus 35.1 +/- 5.9, P = .706, respectively). The rates of hypertensive disorders and gestational diabetes mellitus were significantly lower after the bariatric operation, for the first and the second pregnancy (21% versus 7.4% and 4.7%, P = .009, and 19% versus 5.6% and. 6.6%, P = .007, respectively). The rate of macrosomic newborn was significant lower in the second postbariatric pregnancy (11.1% before versus 1.1% after second pregnancy, P = .02). Using multiple logistic regression models controlling for maternal age, prepregnancy body mass index, and the type of surgery, the reduction in hypertensive disorders (adjusted odds ratio (OR) .3, 95% confidence interval (CI) .12-.82; P = .018 for the first postoperative pregnancy and adjusted OR .2, 95% CI .06-.64; P = .007 for the second postoperative pregnancy), and gestational diabetes mellitus (adjusted OR .2, 95% CI .06-.48; P = .001 for the first postoperative pregnancy and adjusted OR .3, 95% CI .05-.51; P = .002 for the second postoperative pregnancy) remained significant. Conclusions: A significant decrease in pregnancy complications, such as hypertensive disorders and gestational diabetes mellitus, is achieved after a restrictive bariatric surgery. This improvement is maintained at the second subsequent pregnancy. (C) 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.