(1226) Weighing the Risks: Maternal Morbidity and Neonatal Outcomes After Bariatric Surgery

Obesity is a growing crisis and bariatric surgery is a proven, effective solution. However, there is limited international guidance on management of pregnancy following bariatric surgery. This study aimed to evaluate outcomes in this cohort.

Study Design:

This retrospective cohort study included 119 patients with a history of bariatric surgery who delivered between January 2022 - July 2024 at Europe’s largest obstetric unit responsible for 9,000 births annually. Bariatric surgery included Gastric Band, Sleeve Gastrectomy and Gastric Bypass. Data were collected from electronic patient records and described.

Results:

The most commonly performed procedure was a Sleeve Gastrectomy (74%, n=88). Nearly half (48%, n=57) of pregnancies were booked within 18 months post-surgery. Prenatal complications included high rates of Gestational Diabetes (77%, n=92) and Hyperemesis Gravidarum (26%, n=30). Nutritional deficiencies were common with 78% (n=82) of patients’ vitamin D deficient at booking. 36% (n=36) of patients had low ferritin levels worsening to 69% (n=69) by 28 weeks' gestation.

58% (n=51) of patients had induction of labor compared to a baseline rate of 39% at our institution. Caesarean section rate was 42% (n=50) of which 21% (n=25) were performed as an emergency (Table 1). Birth centiles progressively decreased with more invasive bariatric surgical procedures: gastric band > sleeve > bypass. Birthweight was significantly lower following gastric bypass compared to gastric band (p=0.046, Wilcoxon test). (Figure 1).

Conclusion:

This study highlights the importance of pre-operative counselling and post-operative nutritional management in this demographic. There is a clear association of bariatric surgery on maternal morbidity shown by the increased rates of Gestational Diabetes and Hyperemesis Gravidarum. Additionally, the observed differences in birthweight centiles among surgery types suggest that surgical choice may influence neonatal outcomes. This warrants further investigation into the long-term implications of bariatric surgery on maternal and fetal health.