Weight Loss Surgery Lowers Risk of Pregnancy Complications
Obese women who have undergone weight-loss surgery before becoming pregnant are at a lower risk of developing major health problems, according to a study conducted by researchers at the Johns Hopkins University School of Medicine.
Women who have a body mass index greater than 30 are considered obese. Bariatric, or weight-loss, surgery may be appropriate for those who have a BMI over 40, or who have a BMI greater than 35 with a serious medical condition such as type 2 diabetes or uncontrolled hypertension. Weight loss can help increase a woman’s chance of becoming pregnant by improving hormone levels in the body and regulating menstrual cycles.
Women who are obese have a higher risk of developing high blood pressure during pregnancy, called preeclampsia, even if they were not diagnosed with hypertension before conception. Hypertensive disorders, including preeclampsia, eclampsia, and gestational hypertension, can cause both maternal and fetal complications and occur in about 7% of pregnancies in the United States.
Maternal obesity is also a risk factor for other pregnancy-related health conditions, such as gestational diabetes, preterm birth, and congenital abnormalities. The risk of cesarean delivery is three times greater for women with a BMI greater than 35.
In the study, Wendy L Bennett and colleagues analyzed the medical records of 585 obese females ranging in age from 16 to 45. About 300 of them had weight loss surgery before delivering a child, with most having had a gastric bypass. Those women had an 80% lower chance of a diagnosis of preeclampsia or eclampsia during their pregnancy and a 74% reduction in the risk of gestational hypertension. The findings held true even after researchers took into account confounding factors such as preexisting diabetes or maternal age.
Dr. Bennett cautions that not every obese woman is a candidate for weight loss surgery. Also, bariatric surgeons warn women to delay pregnancy for at least 18 months after having the procedure to ensure that the baby gains enough nutrients from mom to support and sustain life.
Most insurance plans have a policy regarding their specific requirements for reimbursement for bariatric surgery, but individual employers may opt out of coverage in an effort to control employee cost. However, Bennett says that insurance plans “should be covering gastric bypass surgery in women of childbearing age because of the potential to reduce complications if we can reduce their weight before they become pregnant.” In addition, it “has the potential of saving a lot of money on treatment of complications in mothers, fetuses, and newborns.”
Bennett W, et al "Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data" BMJ 2010; doi:10.1136/bmj.c1662.