Does Bariatric Surgery Affect Pregnancy in Women in the Childbearing Period? A Retrospective Single Center Study.

BACKGROUND

Severe obesity is a significant public health challenge, affecting women's reproductive health in the childbearing period. Bariatric surgery is an effective weight loss method for management of severe obesity and increase fertility. It may result in nutritional deficiency which adversely affects the maternal and fetal outcome.

METHODS

This was a retrospective study included all women with severe obesity in the childbearing period who underwent bariatric surgery in the period between March 2011 and June 2023. The study cohort was divided into three groups according to fertility status: fertile, infertile, and potential fertility status (unmarried). Fertility rate and pregnancy outcome data were evaluated according to the interval between the bariatric surgery and conception.

RESULTS

Out of 177 women included in the study cohort, 134 women (75.7%) were fertile, 16 (9%) were with infertility, 27 (15.3%) were unmarried. The incidence of PCOS was 13.6%. Overall rate of conception was 28.8% mostly in the women with infertility group (n = 12, 75%) with median interval 20 months from surgery. Pregnancy complications were encountered in 36 women (70.6%), among of which 13 women (86.7%) got pregnant after 2 years from surgery. Anemia was the most common complication (n = 28, 54.9%), followed by hemorrhage (n = 20, 39.2%). Ten neonates (30.3%) were small for gestational age in women with completed pregnancy and no congenital anomalies occurred.

CONCLUSION

Bariatric surgery may improve the fertility rates. However, pregnancies after surgery may result in potential complications particularly if the pregnancy occurs early during the first year and delayed after 2 years from surgery. Lack of adequate multidisciplinary follow-up and specific prenatal program for women after bariatric surgery increases the risk of gestational complications and unfavorable pregnancy outcomes.