Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes After Metabolic and Bariatric Surgery

IMPORTANCE Metabolic and bariatric surgery (MBS) is the most efficient therapeutic option for severe obesity. Most patients who undergo MBS are women of childbearing age. Data in the scientific literature are generally of a low quality due to a lack of well-controlled prospective trials regarding obstetric, neonatal, and child outcomes. OBJECTIVES To assess the risk-benefit balance associated with MBS around obstetric, neonatal, and child outcomes. DESIGN, SETTING, AND PARTICIPANTS The study included 53 813 women on the French nationwide database who underwent an MBS procedure and delivered a child between January 2012 and December 2018. Each women was their own control by comparing pregnancies before and after MBS. EXPOSURES The women included were exposed to either gastric bypass or sleeve gastrectomy. MAIN OUTCOMES AND MEASURES The study team first compared prematurity and birth weights in neonates born before and after maternal MBS with each other. Then they compared the frequencies of all pregnancy and child diagnoses in the first 2 years of life before and after maternal MBS with each other. RESULTS A total of 53 813 women (median [IQR] age at surgery, 30 [26-35] years) were included, among 3686 women who had 1 pregnancy both before and after MBS. The study team found a significant increase in the small-for-gestational-age neonate rate after MBS (+4.4%) and a significant decrease in the large-for-gestational-age neonate rate (-12.6%). The study team highlighted that compared with pre-MBS births, after MBS births had fewer occurrences of gestational hypertension (odds ratio [OR], 0.16; 95% CI, 0.10-0.23) and gestational diabetes for the mother (OR, 0.39; 95% CI, 0.34-0.45), as well as fewer birth injuries to the skeleton (OR, 0.27; 95% CI, 0.11-0.60), febrile convulsions (OR, 0.39; 95% CI, 0.21-0.67), viral intestinal infections (OR, 0.56; 95% CI, 0.43-0.71), or carbohydrate metabolism disorders in newborns (OR, 0.54; 95% CI 0.46-0.63), but an elevated respiratory failure rate (OR, 2.42; 95% CI, 1.76-3.36) associated with bronchiolitis. CONCLUSIONS AND RELEVANCE The risk-benefit balance associated with MBS is highly favorable for pregnancies and newborns but may cause an increased risk of respiratory failure associated with bronchiolitis. Further studies are needed to better assess the middle- and long-term benefits and risks associated with MBS.

Automated summary

Metabolic and bariatric surgery (MBS) is the most efficient therapeutic option for severe obesity. However, the scientific literature lacks high-quality data on the impact of MBS on obstetric, neonatal, and child outcomes. This study found an increased rate of small-for-gestational-age neonates and a decreased rate of large-for-gestational-age neonates after MBS. Additionally, MBS was associated with a lower risk of gestational hypertension and gestational diabetes for the mother, as well as a decrease in birth injuries, febrile convulsions, viral intestinal infections, and carbohydrate metabolism disorders in newborns. However, there was an elevated risk of respiratory failure associated with bronchiolitis after MBS.