Bariatric surgeries are more and more widespread in France. It particularly concerns women of childbearing age. A recent study reveals that it is preferable to wait at least 2 years after a bariatric surgery to embark on a pregnancy. Indeed, the operation can have serious consequences on infants, if the delay is too short. Explanations.
Bariatric surgery, more and more widespread
The surgeries of obesity, or bariatric surgeries, are used in cases of extreme obesity. They are experiencing rapid development in France with nearly 450,000 operations performed between 2006 and 2017. These operations are reserved for people:
- With a body mass index (BMI) > 40 kg/m² or > 35 kg/m² in case of complications such as Type 2 diabetesa hypertension or one sleep apnea syndrome ;
- Aged between 18 and 60;
- Having no psychological contraindications;
- Does not present any particular operational risk.
Bariatric surgeries combine several operating techniques. They are performed under laparoscopy. These operations are not insignificant and require good physical and psychological preparation:
- Restrictive surgical procedures that limit the ability to ingest food. They aim to reduce the volume likely to receive food. This may involve fitting an adjustable gastric band or partial removal of the stomach (Sleeve gastrectomy) ;
- Combination operations combine gastric restriction with the creation of a bypass of the digestive tract (bypass).
They are increasingly common in women of childbearing age. Indeed, they make it possible to reduce the risks associated with obesity during pregnancy such as the preeclampsia where the Gestational Diabetes.
Impact of bariatric surgery on pregnancy
Doctors from the University Hospital of Coimbra in Portugal wanted to study the impact of bariatric surgery on pregnancy. In particular, they investigated the effect of the time interval between bariatric surgery and pregnancy on the health of the newborn. To do this, they conducted a retrospective study of 48 pregnancies that took place after bariatric surgery.
The women included in the study were on average 34.3 years old at the time of childbirth. Their average BMI was 30.9. These women underwent several types of bariatric surgery (gastric bypass, sleeve gastrectomy, gastric banding or biliopancreatic diversion). Furthermore, in 14.6% of cases delivery took place less than 12 months after surgery, in 14.6% of cases between 12 and 24 months later and 70.8% of births took place more than 2 years later.
The results of the study reveal that 26.3% of infants were born too small for their gestational age (PGA). Specifically, the period between surgery and conception was significantly shorter in PGA newborns. Furthermore, analyzes show that the longer the woman waits to conceive, the lower the risk of having a PGA baby. The authors estimate that each month expected reduces this risk by 5%.
Wait 24.5 months after the operation
Thus, this study demonstrates that the optimal waiting period between the bariatric surgery and the pregnancy is 24.5 months. Below, there is 15 times more risk of giving birth to a PGA infant. The risks for small-for-gestational-age infants are manifold. Indeed, they may present at birth with hypothermia, hypoglycaemia, infections or neonatal asphyxia.
Therefore, respecting a time interval of 24.5 months between surgery and conception has a significant impact on the weight and health of the infant. Indeed, a long interval allows women to stabilize their weight loss and nutritional status. Thus, the authors explain that the increased risk of newborn PGA could be related to the rapid weight loss of the mother after bariatric surgery. This would make the expected weight gain during pregnancy difficult. Also, this rapid weight loss would lead to nutritional deficiencies that could impact the health of the unborn child.
It is therefore important that women undergoing bariatric surgery be aware of the risk of early conception and the benefits of delaying pregnancy.
Alexia F., Doctor in Neurosciences
Sources
– Women advised to wait at least two years after weight loss surgery before trying for a baby. easo.org. Accessed May 10, 2022.
– Obesity in adults: drug and surgical treatment. ameli.fr. Accessed May 10, 2022.