Background

Women of reproductive age comprise one-third of patients undergoing bariatric surgery (BS). However, there are limited data on risks of pregnancy in post-BS patients. We examined factors that contribute to pregnancy and peripartum complications in this population.

Methods

A retrospective chart review of singleton, live-birth pregnancies in post-BS patients from 2009-2023 was performed. Mother and neonate weight, pregnancy comorbidities, and peripartum outcomes were collected. Small and large for gestational age (SGA/LGA), pre-term delivery, and obesity were defined using standard criteria. Differences were calculated via chi-square and t-testing.

Results

We evaluated 127 pregnancies in 106 women. Most patients underwent malabsorptive operations (70.6%:72 RYGB, 3 BPD-DS) versus restrictive operations (29.3%: 28 VSG, 3 AGB). Mean age at conception was 32.1+-4.9 years. Mean BMI at BS and conception were 46.9+-9.5kg/m2 and 34.1+-8.1kg/m2, respectively. Median time to conception was 38.5 (IQR 41.5) months. Malabsorptive operations yielded greater mean BMI decrease (-13.41 vs. -10.9kg/m2, p = .02), but was not associated with differences in pregnancy-specific rates of hypertension, diabetes, SGA/LGA neonates, pre-term delivery, or cesarean section (Table). Pre-pregnancy obesity (BMI>30kg/m2) versus BMI<30kg/m2 had higher rates of peripartum hypertension (36.8 vs 16.3%, p = .02), diabetes (44.7 vs 16.3%, p = .005), LGA neonates (36.0 vs 16.7%, p = .03), and cesarean section (52.6 vs 16.3%, p < 0.001).

Conclusions

While peripartum complications were not associated with type of BS, persistent post-BS obesity increased patient risk for peripartum complications. Support to help post-BS patients achieve lower pre-conception weight can likely reduce peripartum complications.