Background

Obesity is an increasingly prevalent disease, affecting the health of millions of individuals. Metabolic and bariatric surgery remains the most effective therapy for severe obesity. Roux-en-Y-Gastric-Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most common bariatric procedures and are associated with durable weight loss and comorbidity resolution. However, the impact of these procedures on obstetric outcomes is underexplored, as women of childbearing age compose the majority of individuals with obesity who undergo bariatric surgery. This retrospective cohort study compares obstetric outcomes in women who gave birth after undergoing SG or RYGB.

Methods

The PearlDiver-Mariner database was used to identify patients who underwent SG or RYGB between 2010-2020 through Current Procedural Terminology and International Classification of Diseases procedure codes. Women ages 18-52 who became pregnant within 2 years of undergoing bariatric surgery were included. Outcomes were defined by the presence of one or more pregnancy related complications. A 1:1 propensity matched analysis was performed with multivariable logistic regression.

Results

16,911 individuals, 10,675(63.1%) and 6,236(36.9%) underwent SG and RYGB, respectively. Obstetric complication rates were 28.3% in the SG vs. 32.1% in the RYGB group (p<0.01). The RYGB group had an increased relative odds of experiencing an obstetric complication compared to the SG group (OR=1.26,95% CI=1.14,1.38).

Conclusions

RYGB was associated with a higher risk of obstetric complications than SG in women who became pregnant within 2 years postoperatively. These findings can help women and surgeons decide which procedure to pursue and inform discussions regarding the timing of pregnancy following surgery.