Kwong W, et al. - Researchers here aimed at assessing the benefits and risks of bariatric surgery in obese women on obstetrical outcomes. Findings suggest that bariatric surgery is associated with a reduction in the risk of several adverse obstetrical outcomes. However, when discussing bariatric surgery with reproductive-age women, they recommend considering a potential for an increased risk of other important outcomes.

Methods

• Researchers performed a systematic literature search using MEDLINE, Embase, Cochrane, Web of Science and PubMed from inception up to December 12, 2016.
• They included studies evaluating patients who underwent bariatric surgery, reporting subsequent pregnancy outcomes, and comparing these outcomes to a control group.
• Two reviewers independently extracted study outcomes.
• Using the Newcastle-Ottawa Quality Assessment Scale, risk of bias was assessed.
• Using the Dersimonian and Laird random effects model, pooled odds ratios (OR) for each outcome were estimated.

Results

• Researchers reviewed 2616 abstracts, and included 20 cohort studies and approximately 2.8 million subjects (8,364 of which had bariatric surgery) in the meta-analysis.
• Subjects undergoing bariatric surgery demonstrated lower rates of gestational diabetes (OR 0.20, CI 0.11 - 0.37, Number needed to benefit (NNTB) 5), large for gestational age infants (OR 0.31, CI 0.17 - 0.59, NNTB 6), gestational hypertension (OR 0.38, CI 0.19 - 0.76, NNTB 11), all hypertensive disorders (OR 0.38, CI 0.27 - 0.53, NNTB 8), postpartum hemorrhage (OR 0.32, CI 0.08 - 1.37, NNTB 21) and C-section rates (OR 0.50, CI 0.38 - 0.67, NNTB 9), but an increase in small for gestational age infants (OR 2.16, CI 1.34 - 3.48, Number needed to harm (NNTH) 21), intrauterine growth restriction (OR 2.16, CI 1.34 - 3.48, NNTH 66), and pre-term deliveries (OR 1.35, CI 1.02 - 1.79, NNTH 35) in comparison to controls matched for pre-surgery body mass index (BMI).
• No differences were identified in rates of preeclampsia, NICU admissions, stillbirths, malformations and neonatal death.
• A greater increase in small for gestational age infants (p=0.0466), and a greater decrease in large for gestational age infants (p=0<0.0001) were observed with malabsorptive surgeries compared with restrictive surgeries.
• Use of administrative databases, relative to clinical charts, revealed no differences in outcomes.