Obese women who have weight-loss surgery before becoming pregnant have a lower risk of pregnancy-related health problems, and their children are less likely to be born with complications, according to a new study by UCLA and the RAND Corp.
Researchers found that women who underwent bariatric surgery and lost weight before becoming pregnant had a significantly lower risk of gestational diabetes and high blood pressure than obese women who did not have surgery. In addition, their babies were less likely to be born prematurely, underweight or overweight than children born to obese women.
The study appears in the Nov. 19 edition of the Journal of the American Medical Association.
"Obese women who undergo bariatric surgery and lose weight prior to becoming pregnant may improve their own health, as well as their children's health," said lead author Dr. Melinda A. Maggard, associate professor of surgery at the David Geffen School of Medicine at UCLA and a researcher at the RAND Corp., a nonprofit research organization. "Further research is needed, but the results seen thus far are positive."
The incidence of bariatric surgery increased eightfold in the United States from 1998 to 2005, with women between the ages of 18 and 45 accounting for 83 percent of the procedures. More than 150,000 women of childbearing age underwent bariatric surgery from 2002 to 2005. Bariatric surgery refers to weight-loss procedures involving the surgical modification of the gastrointestinal tract.
With more women of childbearing age undergoing bariatric surgery, researchers from the Southern California Evidence-Based Practice Center wanted to assess the available evidence on medical outcomes for these women and their newborns.
The study team — made up primarily of researchers from the David Geffen School of Medicine at UCLA, RAND Health and the Veterans Affairs Greater Los Angeles Healthcare System — conducted the study by reviewing results from 75 studies that examined health issues among women who had undergone bariatric surgery and their children.
Studies examining complication rates among women who had undergone weight-loss surgery prior to becoming pregnant found that their rates of gestational diabetes and high blood pressure were nearly as low as those seen among women who had never been obese. The impact of mothers' bariatric surgery on health complications among their newborns was even more significant.
Researchers also found evidence that fertility rates improved among women who had undergone bariatric surgery, but the evidence was limited in scope. Other research has shown that fertility improves among obese women who lose weight using nonsurgical methods.
Although rare, complications from bariatric surgery can occur during pregnancy, according to the study. The most common complication is an internal hernia that causes intestinal problems. Most surgeons recommend that women delay pregnancy for a year following bariatric surgery — the period when the most rapid weight loss occurs.
Support for the study was provided by the U.S. Agency for Healthcare Research and Quality, which provides ongoing support to the Southern California Evidence-Based Practice Center. The center is based at RAND and the VA Greater Los Angeles Healthcare System.
Other study authors are Sydne Newberry, Marika Suttorp and Lara Hilton of RAND; Margaret Maglione of RAND and the David Geffen School of Medicine at UCLA; Dr. Paul G. Shekelle of RAND, the VA Greater Los Angeles Healthcare System and the Geffen School of Medicine; Dr. Irina Yermilov and Dr. Zhaoping Li of the Geffen School of Medicine and the VA Greater Los Angeles Healthcare System; Dr. Heena P. Santry of Massachusetts General Hospital; Dr. John. M. Morton of the Stanford University School of Medicine; and Dr. Edward H. Livingston of the University of Texas Southwest School of Medicine.
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