Restrictive Versus Malabsorptive Bariatric Procedures in Obese Women of Reproductive Age

Aaron Purser1, Sallie McSwain1, Angel Farinas, MD2, Christian Cruz, MD2, Angelina Postoev, MD2, Christopher Ibikunle, MD2, Aliu Sanni, MD2. 1GRU/UGA Medical Partnership, 2Georgia Surgicare

INTRODUCTION: In 2011–2012 in the United States, 36% of adult women were obese, and the majority of women in early pregnancy were either overweight or obese. Increasing numbers of young women of reproductive age seek bariatric surgery each year to achieve sustained weight loss and improve associated co-morbidities. The objective of this study is to evaluate maternal and fetal outcomes following restrictive or malabsorptive bariatric surgery.

METHODS: A systematic review was conducted through PubMed to identify relevant studies with comparative data on the potential adverse maternal and fetal outcomes when comparing restrictive vs malabsorptive bariatric procedures in obese women of reproductive age. Specifically, the different adverse outcomes when undergoing restrictive [laparoscopic sleeve gastrectomy, open vertical and laparoscopic adjustable gastric banding, silastic ring vertical gastroplasty] versus malabsorptive [gastric bypass (Roux-en-Y), and bilopancreatic diversion] bariatric procedures were all identified. The primary outcome analysed was fetal loss. Secondary outcomes included prematurity, NICU admissions, SGA (small for gestational age), APGAR scores, birth weight, and rate of caesarean delivery. Results are expressed as standard difference in means with standard error. Statistical analysis was done using fixed-effects meta-analysis to compare the mean value of the two groups. (Comprehensive Meta-Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).

RESULTS: Four out of 94 studies were quantitatively assessed and included for meta-analysis, all of which included retrospective studies at a variety of institutions. Among the four studies, 511 births represented a past history of restrictive bariatric surgery, whereas 242 births represented a past history of malabsorptive bariatric surgeries. The incidence of SGA was noted to be significantly higher in patients undergoing malabsorptive bariatric surgery (-0.527±0.159, p<0.001) when compared to the restrictive surgery. There were no difference in the incidence of fetal loss (0.209±0.036, p<0.734), preterm labour (-0.055±0.103, p <0.592), NICU admissions (-0.083±0.179, p <0.642), rate of APGAR scores <7 at 5 mins (-0.081±0.120, p <0.504), birth weight (-0.023±0.113, p<0.841) and rate of Caesarean delivery (-0.001±0.122, p <0.996) amongst the two different procedures.

CONCLUSION: Restrictive or malabsorptive bariatric surgery offers similar outcomes in patients of reproductive age group that desire future pregnancies. Patients undergoing malabsorptive surgery may deliver babies of small gestational age when compared to the restrictive group.

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