Delay Pregnancy at Least 12 Months After Bariatric Surgery, Review Suggests

The available evidence related to the safety, advantages, and disadvantages of bariatric surgery indicate that women should wait 12 to 18 months after weight-loss surgery before trying to become pregnant, according to an evidence-based literature review.¹

Morbid obesity is associated with pregnancy complications such as miscarriage, gestational diabetes, preeclampsia, antepartum stillbirth, cesarean or instrumental delivery, shoulder dystocia, meconium aspiration, fetal distress, early neonatal death, and large for gestational age.^2,3 According to the review authors, there is an exponential increase in the number of morbidly obese women of childbearing age who choose bariatric surgery as treatment of their obesity.¹ Overall, pregnancy after bariatric surgery is safer and associated with fewer complications than pregnancy in women who are morbidly obese. The review cites one study that found that nearly 80% of women who had undergone bariatric surgery had no complications during their pregnancy.¹

Although pregnancy is safer after bariatric surgery, there are risks during pregnancy after weight-loss surgery. Surgical complications related to pregnancy after bariatric surgery include band slippage and migration, which can cause severe vomiting and reflux, and band leakage, which can result in weight gain. These complications have been reported in 24% of pregnancies following bariatric surgery, according to the review authors.¹

To minimize pregnancy complications, the authors suggest that women wait 12 to 18 months to become pregnant after bariatric surgery. Evidence has shown that there is a higher rate of spontaneous miscarriage among women who become pregnant within 18 months after bariatric surgery compared with women who become pregnant after 18 months of surgery (31% vs 18%, respectively).¹

A multidisciplinary team, which may include obstetricians, surgeons, primary care clinicians, anesthesiologists, fertility specialists, nutritionists, psychologists, and plastic surgeons, is also needed to help prevent nutrition-related and surgical complications. Currently, there are no recommendations related to nutrition in pregnancy specifically for women who have undergone bariatric surgery.

“Multidisciplinary input care is the key to a healthy pregnancy for women who have undergone bariatric surgery. However, this group of women should still be considered high risk by both obstetricians and surgeons,” said Rahat Khan, MD, a coauthor of the review.⁴

Pertinent Points:
- In general, women who have undergone bariatric surgery tolerate pregnancy well.
- Women should wait at least 12 to 18 months after bariatric surgery before trying to become pregnant.
- Pregnancy in women who have undergone bariatric surgery is safer and associated with fewer complications than pregnancy in morbidly obese women.
 

References:

1. Khan R, Dawlatly B, Chappatte O. Pregnancy outcome following bariatric surgery. The Obstetrician & Gynaecologist. 2013;15:37-43. 

2. Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29:507-513.

3. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103:219-224.

4. Women should wait at least 12 months before trying for a baby following weight loss surgery. Press release. Available at: http://www.eurekalert.org/pub_releases/2013-01/w-wsw010913.php. Accessed January 15, 2013.