Investigating the association between pregnancy following bariatric surgery and adverse perinatal outcomes: A systematic review and meta‐analysis

A systematic review and meta‐analysis

Zainab Akhter, Judith Rankin, Rute Vieira, Lem Ngongalah, Roland Devlieger, Roger Ackroyd, Nicola Heslehurst

Research output: Contribution to journalAbstract

Abstract

Objectives

To investigate the association between pregnancy after bariatric surgery and adverse perinatal outcomes.

Design

Systematic review and meta‐analysis of current evidence base to collate findings and identify research gaps. PROSPERO registration: CRD42017051537.

Methods

Six electronic databases were searched from inception to June 2017 and supplemented by searches of reference lists, citations and relevant journals. The primary outcomes are congenital anomalies and perinatal mortality. Secondary outcomes include additional adverse perinatal outcomes such as preterm birth and small‐for‐gestational‐age (SGA) neonates. Observational studies published in English language that used obesity or BMI‐matched controls were included. Assessment for suitability of pooling data to Meta‐analyse is on‐going.

Results

Seventeen studies were included with 7742 women who had bariatric surgery prior to pregnancy and 205 796 controls. The studies seem to suggest a reduced risk of macrosomia, large‐for‐gestational‐age (LGA) neonates and post‐term birth but an increased risk of preterm birth and SGA neonates. An increased risk of NICU admission, miscarriage and perinatal mortality were observed in single studies. Only two studies investigated congenital anomalies but had conflicting results and associations were not significant.

Conclusions

Bariatric surgery prior to pregnancy appears to be associated with increased risk of SGA neonates and preterm birth. The use of small sample sizes in multiple studies may have resulted in non‐significance and large confidence intervals for rare outcomes. Meta‐analysis will address this limitation to some extent by increasing power. Larger scale studies of national and international data are required to overcome sample size limitations for rare outcomes.
Original languageEnglish
Pages (from-to)PP.014
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume125
Issue numberS2
DOIs
Publication statusPublished - Apr 2018
EventBritish Maternal & Fetal Medicine Society (BMFMS) 20th Annual Conference 2018 - Brighton, UK
Duration: 19 Apr 201820 Apr 2018

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Bariatric Surgery
Premature Birth
Newborn Infant
Pregnancy
Perinatal Mortality
Sample Size
Spontaneous Abortion
Observational Studies
Meta-Analysis
Language
Obesity
Parturition
Databases
Confidence Intervals
Research

Cite this

Investigating the association between pregnancy following bariatric surgery and adverse perinatal outcomes: A systematic review and meta‐analysis : A systematic review and meta‐analysis. / Akhter, Zainab; Rankin, Judith; Vieira, Rute; Ngongalah, Lem; Devlieger, Roland; Ackroyd, Roger; Heslehurst, Nicola.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 125, No. S2, 04.2018, p. PP.014.

Research output: Contribution to journalAbstract

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abstract = "ObjectivesTo investigate the association between pregnancy after bariatric surgery and adverse perinatal outcomes.DesignSystematic review and meta‐analysis of current evidence base to collate findings and identify research gaps. PROSPERO registration: CRD42017051537.MethodsSix electronic databases were searched from inception to June 2017 and supplemented by searches of reference lists, citations and relevant journals. The primary outcomes are congenital anomalies and perinatal mortality. Secondary outcomes include additional adverse perinatal outcomes such as preterm birth and small‐for‐gestational‐age (SGA) neonates. Observational studies published in English language that used obesity or BMI‐matched controls were included. Assessment for suitability of pooling data to Meta‐analyse is on‐going.ResultsSeventeen studies were included with 7742 women who had bariatric surgery prior to pregnancy and 205 796 controls. The studies seem to suggest a reduced risk of macrosomia, large‐for‐gestational‐age (LGA) neonates and post‐term birth but an increased risk of preterm birth and SGA neonates. An increased risk of NICU admission, miscarriage and perinatal mortality were observed in single studies. Only two studies investigated congenital anomalies but had conflicting results and associations were not significant.ConclusionsBariatric surgery prior to pregnancy appears to be associated with increased risk of SGA neonates and preterm birth. The use of small sample sizes in multiple studies may have resulted in non‐significance and large confidence intervals for rare outcomes. Meta‐analysis will address this limitation to some extent by increasing power. Larger scale studies of national and international data are required to overcome sample size limitations for rare outcomes.",
author = "Zainab Akhter and Judith Rankin and Rute Vieira and Lem Ngongalah and Roland Devlieger and Roger Ackroyd and Nicola Heslehurst",
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