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Women who undergo bariatric surgery (weight-loss surgery) should wait at least one year before trying to get pregnant. The finding came from a review, published in The Obstetrician & Gynaecologist (TOG), that examined prior research to evaluate the safety, benefits, and restrictions associated with bariatric surgery, and management of weight-loss surgery patients before, during, and after pregnancy. The prevalence of obesity among women of child-bearing age is anticipated to increase from about 24.2% in 2005 to an estimated 28.3% in 2015, while the number of females having weight-loss surgery is rising. Although obesity has been associated with infertility, past studies indicated that bariatric surgery may treat its most frequent cause, polycystic ovarian syndrome (PCOS). The risk of pregnancy complications increases with obesity, however, women who get pregnant after having bariatric surgery have a lesser chance of problems than women who are extremely obese. One study which followed pregnancies after women had bariatric surgery showed that 79.2% of subjects had no issues during their pregnancy. However, the researchers noted, there can be surgical complications during pregnancy for women who have had weight-loss surgery. Prior research demonstrated a few issues that may occur, such as band slippage and migration, which may cause severe vomiting. In the report, 24% of the women experienced band leakage. After careful review on the research available, the researchers suggested that women should wait at least 12 months after having bariatric surgery to get pregnant. However, the authors pointed out that one study found an increased spontaneous miscarriage rate of 31% among women who became pregnant within 18 months of undergoing bariatric surgery compared to 18% among those who waited more than 18 months after surgery to have a baby. According to the review, patients should seek guidance and information before conceiving on subjects such as: In order to have the best outcome for both mom and her child, a multidisciplinary team is necessary during and after pregnancy following weight loss surgery, including:surgeonsprimary care doctorsobstetriciansanaesthetistsnutritionistspsychologistsplastic surgeonsfertility specialistspatients themselves Rahat Khan, Consultant Obstetrician and Gynecologist, Princess Alexandra Hospital NHS Trust, Harlow and co- author of the report, explained: “An increasing number of women of child-bearing age are undergoing bariatric surgery procedures and need information and guidance regarding reproductive issues. In light of current evidence available, pregnancy after bariatric surgery is safer, with fewer complications, than pregnancy in morbidly obese women. Multidisciplinary input care is the key to a healthy pregnancy for women who have undergone bariatric surgery. However, this group of women should still be considered high risk by both obstetricians and surgeons. Primary care doctors, surgeons, and obstetricians will be increasingly obligated to focus on concerns their patients have regarding the safety of getting pregnant after receiving weight loss surgery, Khan added. Jason Waugh, TOG’s Editor-in-Chief, concluded: “Pregnancy after bariatric surgery is safer than pregnancy in morbidly obese women. Women who have had bariatric surgery generally tolerate pregnancy well. However, there are risks involved and patients must be well informed. Optimal education should be encouraged in these individuals so that they can make well informed decisions about planning pregnancy after their surgery.” Written by Sarah Glynn
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