title: Obstetric outcomes after restrictive bariatric surgery: what happens after 2 consecutive pregnancies?
abstract: BACKGROUND
  The objective of this study was to compare the outcomes of 2 consecutive pregnancies of the same women who conceived after restrictive bariatric surgeries.
  
  
  METHODS
  A retrospective study comparing consecutive pregnancy outcomes of the same women, who conceived before and twice after a restrictive bariatric surgery, was conducted.
  
  
  RESULTS
  This study included 109 women, and therefore, 327 paired pregnancies: 109 pregnancies preceded and 218 followed restrictive bariatric surgery (87% had laparoscopic banding, and 13% had silastic ring vertical gastroplasty). Both prepregnancy and predelivery body mass index were significantly lower after bariatric surgery (36.7±4.4 versus 31. 5±5.5, P<.001; 40.6±5.5 versus 35.3±6.1, P<.001; respectively). This effect was preserved at the subsequent pregnancy (31.5±5.5 versus 31.3±6.3, P = .609, and 35.3±6.1 versus 35.1±5.9, P = .706, respectively). The rates of hypertensive disorders and gestational diabetes mellitus were significantly lower after the bariatric operation, for the first and the second pregnancy (21% versus 7.4% and 4.7%, P = .009, and 19% versus 5.6% and. 6.6%, P = .007, respectively). The rate of macrosomic newborn was significant lower in the second postbariatric pregnancy (11.1% before versus 1.1% after second pregnancy, P = .02). Using multiple logistic regression models controlling for maternal age, prepregnancy body mass index, and the type of surgery, the reduction in hypertensive disorders (adjusted odds ratio (OR) .3, 95% confidence interval (CI) .12-.82; P = .018 for the first postoperative pregnancy and adjusted OR .2, 95% CI .06-.64; P = .007 for the second postoperative pregnancy), and gestational diabetes mellitus (adjusted OR .2, 95% CI .06-.48; P = .001 for the first postoperative pregnancy and adjusted OR .3, 95% CI .05-.51; P = .002 for the second postoperative pregnancy) remained significant.
  
  
  CONCLUSIONS
  A significant decrease in pregnancy complications, such as hypertensive disorders and gestational diabetes mellitus, is achieved after a restrictive bariatric surgery. This improvement is maintained at the second subsequent pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Amsalem
authors.affiliation: Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
authors.forename: Barak
authors.initials: B
authors.lastname: Aricha-Tamir
authors.affiliation: Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
authors.forename: Issac
authors.initials: I
authors.lastname: Levi
authors.affiliation: Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shai
authors.affiliation: Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel. Electronic address: Sheiner@bgu.ac.il.
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D036861:Delivery, Obstetric / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D016017:Odds Ratio; D011184:Postoperative Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Diabetes mellitus; Hypertensive disorders; Obesity; Pregnancy; Restrictive bariatric surgery