Bariatric Surgery Cuts More than Just Pounds

Obese women who have bariatric surgical procedures before pregnancy were three times less likely to develop gestational diabetes (GDM) than women who have bariatric operations after delivery, according to research published in the Journal of the American College of Surgeons. The retrospective study also found that delivery after bariatric procedures was associated with reduced odds of cesarean section—an outcome associated with GDM.

Gestational diabetes affects at least 7% of all pregnancies in the US, with rates as high as 14% among certain populations. Its prevalence is increasing among reproductive-age women, along with obesity and type 2 diabetes. Currently, 33% of women over 19 years of age meet the criteria for obesity (BMI > 30 kg/m2) and 7% for extreme obesity (BMI > 40 kg/m2). Bariatric surgical procedures are the only intervention shown to produce sustained weight reduction in the vast majority of subjects.

“The major finding of our study is that women who had bariatric surgery before they delivered reduced odds of gestational diabetes when compared with women had bariatric surgery after they delivered,” said Anne E. Burke, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, MD, in a statement.

“Despite a growing body of evidence supporting the safety and efficacy of bariatric surgery in reversing obesity-related complications, few candidates for the procedure are referred to a surgeon to discuss their options,” stated Martin Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine and senior author of the study.

Researchers performed a retrospective study to compare rates of GDM and related outcomes between a group of women who had bariatric operations before pregnancy and a group who had bariatric operations after delivery between 2002 and 2006. Women who delivered after bariatric procedures had lower incidences of GDM (8% vs. 27%) and cesarean section (28% vs. 43%) than those who delivered before bariatric procedures.

Women who delivered after bariatric operations were slightly older (32.5 years vs. 31.1 years), and the median time from surgical procedure to delivery was 19.6 months, which meant that the majority of women did not adhere to the current recommendation to defer pregnancy for two years after bariatric procedures were performed. Deliveries before bariatric operations occurred at a median time of 16.5 months, meaning that most women waited more than a year after delivery before having bariatric procedures. The majority of women in each group had a bypass procedure (75% in the prebariatric delivery group and 87% in the postbariatric delivery group). Women who had a prebariatric delivery were more likely to have an adjustable banding procedure than women with a postbariatric delivery (9% vs. 3%).

For more:

• Bariatric Surgery a Type 2 Diabetes Cure?
• American Journal of Obstetrics and Gynecology—Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery
• Critical Care Nursing Quarterly—Emerging issues for the postbariatric surgical patient

Have you recommended bariatric surgery to women prior to their pregnancy? If so, what were the results of the surgery? Do you find that some of your colleagues are still hesitant to recommend the procedure?