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Original Investigation
October 19, 2016

Bariatric Surgery in Women of Childbearing Age, Timing Between an Operation and Birth, and Associated Perinatal Complications

Author Affiliations
  • 1Department of Surgery, University of Washington Medical Center, Seattle
  • 2Department of Epidemiology, University of Washington School of Public Health, Seattle
  • 3Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle
JAMA Surg. Published online October 19, 2016. doi:10.1001/jamasurg.2016.3621
Key Points

Question  In women of childbearing age, is a prior bariatric operation associated with risks for perinatal complications, and does the time between an operation and birth alter these risks?

Findings  In this cohort study, mothers with prior bariatric surgery had infants with significantly higher risks for prematurity, small-for-gestational-age status, and intensive care unit admission. Operation-to-birth intervals of less than 2 years were associated with the highest risks for prematurity and intensive care unit admission.

Meaning  Bariatric operations in women of childbearing age are associated with elevated risks for subsequent perinatal complications, but some of these risks may decrease after postoperative year 2.

Abstract

Importance  Metabolic changes after maternal bariatric surgery may affect subsequent fetal development. Many relevant perinatal outcomes have not been studied in this postoperative population, and the risks associated with short operation-to-birth (OTB) intervals have not been well examined.

Objective  To examine the risk for perinatal complications in women with a history of bariatric surgery (postoperative mothers [POMs]) by comparing them with mothers without operations (nonoperative mothers [NOMs]) and examining the association of the OTB interval with perinatal outcomes.

Design, Setting, and Participants  This investigation was a population-based retrospective cohort study (January 1, 1980, to May 30, 2013) at hospitals in Washington State. Data were collected from birth certificates and maternally linked hospital discharge data. Participants were all POMs and their infants (n = 1859) and a population-based random sample of NOMs and their infants frequency matched by delivery year (n = 8437).

Exposures  Bariatric operation before birth or categories of OTB intervals.

Main Outcomes and Measures  The primary outcomes were prematurity, neonatal intensive care unit (NICU) admission, congenital malformation, small for gestational age (SGA), birth injury, low Apgar score (≤8), and neonatal mortality. Poisson regression was used to compute relative risks (RRs) and 95% CIs, with adjustments for maternal body mass index, delivery year, socioeconomic status, age, parity, and comorbid conditions.

Results  A total of 10 296 individuals were included in the analyses for this study. In the overall cohort, the median age was 29 years (interquartile range, 24-33 years). Compared with infants from NOMS, infants from POMs had a higher risk for prematurity (14.0% vs 8.6%; RR, 1.57; 95% CI, 1.33-1.85), NICU admission (15.2% vs 11.3%; RR, 1.25; 95% CI, 1.08-1.44), SGA status (13.0% vs 8.9%; RR, 1.93; 95% CI, 1.65-2.26), and low Apgar score (17.5% vs 14.8%; RR, 1.21; 95% CI, 1.06-1.37). Compared with infants from mothers with greater than a 4-year OTB interval, infants from mothers with less than a 2-year interval had higher risks for prematurity (11.8% vs 17.2%; RR, 1.48; 95% CI, 1.00-2.19), NICU admission (12.1% vs 17.7%; RR, 1.54; 95% CI, 1.05-2.25), and SGA status (9.2% vs 12.7%; RR, 1.51; 95% CI, 0.94-2.42).

Conclusions and Relevance  Infants of mothers with a previous bariatric operation had a greater likelihood of perinatal complications compared with infants of NOMs. Operation-to-birth intervals of less than 2 years were associated with higher risks for prematurity, NICU admission, and SGA status compared with longer intervals. These findings are relevant to women with a history of bariatric surgery and could inform decisions regarding the optimal timing between an operation and conception.

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