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Women advised to delay pregnancy after obesity surgery
Experts say pregnancy after bariatric surgery is best left until at least 12 months after the operation
11th January 2013 - With obesity among women of reproductive age expected to rise, from 24.2% in 2005 to 28.3% in 2015, so too is the number of women undergoing weight loss (bariatric) surgery.
However, a new evidence-based literature review published in The Obstetrician & Gynaecologist (TOG) advises women to wait at least 12 months before trying for a baby following a weight loss operation.
The review states that pregnancy after bariatric surgery is safer than pregnancy in morbidly obese women. A previous study following pregnancies after weight loss surgery found 79.2% of participants had no complications during their pregnancy.
However, there can be problems. Another study found that gastric band slippage and migration can occur, resulting in severe vomiting, and band leakage was reported in 24% of pregnancies.
Based on the current evidence available, the authors of the review recommend that patients should not get pregnant for at least 12 months following bariatric surgery, which is when rapid weight loss occurs. Also, it's during the first year after surgery that nutritional deficiencies or electrolyte imbalance can arise.
Although the experts are saying women should wait at least 12 months before trying for a baby one study found a higher spontaneous miscarriage rate among pregnancies occurring within 18 months of having weight loss surgery compared with those pregnancies occurring more than 18 months after surgery (31% versus 18%).
The review also recommends that women should receive advice and information pre- conception on topics such as contraception, nutrition and weight gain and vitamin supplementation.
The review concludes that a successful pregnancy following weight loss surgery requires a multidisciplinary team including obstetricians, surgeons, primary care clinicians, anaesthetists, fertility specialists, nutritionists, psychologists and plastic surgeons.
Decreased weight - increased questions
The review says that increasingly obstetricians, surgeons and primary care clinicians will be required to address questions about the safety of pregnancy after weight loss surgery.
Rahat Khan, co- author of the review and Consultant Obstetrician and Gynaecologist, Princess Alexandra Hospital NHS Trust, Harlow, Essex, says in a press release:"An increasing number of women of child-bearing age are undergoing bariatric surgery procedures and need information and guidance regarding reproductive issues. In light of current evidence available, pregnancy after bariatric surgery is safer, with fewer complications, than pregnancy in morbidly obese women.
"Multidisciplinary input care is the key to a healthy pregnancy for women who have undergone bariatric surgery. However, this group of women should still be considered high risk by both obstetricians and surgeons."
The Obstetrician & Gynaecologist Editor-in-Chief, Jason Waugh says in a media statement:"Women who have had bariatric surgery generally tolerate pregnancy well. However, there are risks involved and patients must be well informed.
"Optimal education should be encouraged in these individuals so that they can make well informed decisions about planning pregnancy after their surgery."