Pregnancy after bariatric surgery : investigating perinatal outcomes and healthcare

Abstract

Bariatric surgery is the most effective obesity treatment. Most patients are women of reproductive age, and the impact on nutrition could affect subsequent pregnancies. This PhD aimed to investigate pregnancy outcomes after bariatric surgery. There were five stages to this research programme. The first stage was a synthesis of systematic reviews. Findings showed that maternal outcomes were improved following bariatric surgery, including gestational diabetes, hypertension, and fertility. The evidence-base was limited for perinatal outcomes. The second stage was a meta-analysis of perinatal observational data, which showed higher odds of small-for-gestational-age babies, pre-term birth, and neonatal intensive care admission after bariatric surgery; and reduced odds of large-for-gestational-age and post term birth. Gastric bypass had higher odds of small-for-gestational-age infants compared to gastric banding. The third stage investigated maternal risk factors associated with a small-for-gestational-age baby following bariatric surgery. The case-control study found that mothers of small-for gestational-age babies gained less weight during pregnancy and were less likely to receive preconception nutritional advice compared to those delivering an appropriate-for gestational-age baby. The fourth stage was a survey of healthcare professionals in England. Respondents felt that women with previous bariatric surgery were a high-risk obstetric group with specialised nutritional needs. However, there were barriers to providing preconception and pregnancy care due to lack of training, resources, and disconnect between obesity and maternity services. The final stage demonstrated in a proof-of-concept study that it is possible to link bariatric surgery from Hospital Episode Statistics to babies from the National Congenital Anomaly and Rare Disease Registration Service. This linkage will allow the first study of congenital anomalies following bariatric surgery in England to be conducted. With the provision of specialised nutritional support and monitoring, bariatric surgery has the potential to improve pregnancy outcomes for both mother and baby. Future research may indicate preferences for a specific procedure or surgery-to-conception interval.