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Adverse perinatal outcomes after Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy : a systematic review

Kistner, Astrid ; Werner, Alva and Zaigham, Mehreen LU orcid (2023) In BMC Pregnancy and Childbirth 23(1).
Abstract

BACKGROUND: Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG).

METHODS: A systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time... (More)

BACKGROUND: Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG).

METHODS: A systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time from surgery to conception, birth weight, gestational age and intrauterine fetal death. Article selection, risk of bias assessment and data extraction, were performed by two authors. The study protocol was published in its revised form in PROSPERO, registration number: CRD42021234480.

RESULTS: A total of 3201 records were extracted. After duplicates were removed, 3143 records were screened for inclusion. Six studies fitted the selection criteria, of which four studies were RYGB and two SG (1100 post-RYGB vs. 209 post-SG). For the included studies, higher incidence of both SGA (22.9%, 11.9%, 14.2%) and LGA (4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%) were observed. SG had a shorter surgery to conception interval as compared to RYGB. Risk of bias assessment was moderate to serious for the studies included in the review, with bias in selection of participants being the major reason.

CONCLUSION: Our systematic review demonstrated no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG. The rate of SGA and LGA births were higher in the SG group, but this group also had a shorter surgery to conception interval. Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes.

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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Female, Pregnancy, Gastric Bypass/adverse effects, Obesity, Morbid/surgery, Bariatric Surgery, Parturition, Gastrectomy/adverse effects, Retrospective Studies, Treatment Outcome
in
BMC Pregnancy and Childbirth
volume
23
issue
1
article number
557
publisher
BioMed Central (BMC)
external identifiers
  • pmid:37532995
  • scopus:85166425323
ISSN
1471-2393
DOI
10.1186/s12884-023-05515-7
language
English
LU publication?
yes
id
d6752e29-409f-4dc1-8755-c1e07d6fd8c8
date added to LUP
2023-08-05 20:49:34
date last changed
2024-02-19 22:05:27
@article{d6752e29-409f-4dc1-8755-c1e07d6fd8c8,
  abstract     = {{<p>BACKGROUND: Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG).</p><p>METHODS: A systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time from surgery to conception, birth weight, gestational age and intrauterine fetal death. Article selection, risk of bias assessment and data extraction, were performed by two authors. The study protocol was published in its revised form in PROSPERO, registration number: CRD42021234480.</p><p>RESULTS: A total of 3201 records were extracted. After duplicates were removed, 3143 records were screened for inclusion. Six studies fitted the selection criteria, of which four studies were RYGB and two SG (1100 post-RYGB vs. 209 post-SG). For the included studies, higher incidence of both SGA (22.9%, 11.9%, 14.2%) and LGA (4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%) were observed. SG had a shorter surgery to conception interval as compared to RYGB. Risk of bias assessment was moderate to serious for the studies included in the review, with bias in selection of participants being the major reason.</p><p>CONCLUSION: Our systematic review demonstrated no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG. The rate of SGA and LGA births were higher in the SG group, but this group also had a shorter surgery to conception interval. Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes.</p>}},
  author       = {{Kistner, Astrid and Werner, Alva and Zaigham, Mehreen}},
  issn         = {{1471-2393}},
  keywords     = {{Humans; Female; Pregnancy; Gastric Bypass/adverse effects; Obesity, Morbid/surgery; Bariatric Surgery; Parturition; Gastrectomy/adverse effects; Retrospective Studies; Treatment Outcome}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Pregnancy and Childbirth}},
  title        = {{Adverse perinatal outcomes after Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy : a systematic review}},
  url          = {{http://dx.doi.org/10.1186/s12884-023-05515-7}},
  doi          = {{10.1186/s12884-023-05515-7}},
  volume       = {{23}},
  year         = {{2023}},
}