Abstract

Background: Obesity is a widespread health issue caused by a combination of genetic and environmental factors. The prevalence of obesity is increasing globally, including in Belgium. Bariatric surgery is often used as a treatment option for patients with higher classes of obesity. However, there is a growing population of women who have undergone bariatric surgery and are either planning to become pregnant or are already pregnant. This population poses unique challenges and requires further research to guide their management during pregnancy. There are two main groups of bariatric surgery, malabsorptive and restrictive. This systematic review and meta-analysis aimed to compare perinatal outcomes, specifically birth weight, preterm birth, and early and late pre-eclampsia, between different types of restrictive procedures, namely gastric sleeve and gastric banding.

Methods: English or Dutch language articles were identified in a Medline, Embase, and Cochrane Library search without publication date restriction using the keywords for pregnancy and bariatric surgery or gastric sleeve or gastric banding. A total of 16 studies were included in the review, consisting of case-control studies, cohort studies, reviews, and guidelines. Meta-analysis was performed using a random effects model.3

Results: The meta-analysis of four studies revealed that gastric banding was associated with a reduced risk of having a Small for Gestational Age (SGA) baby compared to obese women without bariatric surgery. Similarly, the odds of having a Large For Gestational Age (LGA) infant were lower after gastric banding. However, these findings were not statistically significant. Gastric banding did show a significant reduction in the risk of developing gestational hypertension and pre-eclampsia compared to obese women. The meta-analysis showed no statistically significant difference in the risk of preterm delivery between gastric banding and obesity.

Conclusion: The results suggest that gastric banding may have beneficial effects on perinatal outcomes, including a reduced risk of SGA, LGA, gestational hypertension, and pre-eclampsia. It is recommended that restrictive bariatric surgery be considered in women of reproductive age to minimize pregnancy complications. The current evidence does not allow us to compare the differences in perinatal outcomes between gastric banding and sleeve gastrectomy. Most of the research has been done on gastric banding, and there is little evidence about perinatal outcomes after sleeve gastrectomy. More trials are needed to compare the effects of sleeve gastrectomy and gastric banding on pregnancy outcomes.

Keywords: Obesity; Bariatric surgery; Pregnancy; Complications; Genetics; Patients