As concerns over obesity and its impact on pregnancies continue to grow in the healthcare community, researchers are exploring viable weight loss options for pregnant women. With bariatric surgery gaining popularity, new studies have explored the safety and effectiveness of the gastric band and pregnancy, and whether this form of weight loss surgery is advisable for expectant mothers who are obese. Now, recent research is revealing that gastric banding is indeed safe for young women who are pregnant as well as for those who want to get pregnant in the future.
Obesity’s Potential Impact During Pregnancy
Obesity is a medical condition characterized by the accumulation of excess body fat, usually a result of the interplay between poor diet choices, sedentary lifestyle and genetic factors, affecting as much as 37% of young women aged 20 to 39 years. Obese patients are diagnosed using the calculation of the body mass index (BMI) and are at higher risk of heart disease, diabetes, obstructive sleep apnea, osteoarthritis and some types of cancer.
Furthermore, obesity is also associated with numerous negative impacts both in fertility and pregnancy. Obesity, due to the hormonal effects in the body including uncontrolled production of estrogen, is associated with irregular menstruation, infertility and miscarriage. In pregnancy, it has been shown in previous studies that obese women have a higher risk of pregnancy-associated diabetes and hypertension, large babies, and cesarean section, among others.
The management of obese women can be challenging. The first approach usually involves a combination of dietary changes and exercise. As most drugs used to lose weight have questionable efficacy, patients with obesity that is refractory (unresponsive) to these interventions are frequently advised to undergo bariatric surgery.
Sleeve Gastrectomy and Pregnancy: Safety and Efficacy
The sleeve gastrectomy or gastric sleeve is a weight-loss surgery in which a large portion of the stomach is removed reducing its size to about 1/4 of the original size. This procedure is done through small (0.5-1.5 cm) incisions and with the help of a camera (laparoscopy), and is permanent (not reversible). Although the volume of the stomach is reduced, it tends to function normally and weight loss is achieved due to the restriction of food intake. As the area removed contains cells that stimulate hunger, the end-result is that the surgery helps lower weight by reducing caloric intake and hunger combined.
A recent meta-analysis, that is a combination of all studies about the effects of bariatric surgery in pregnancy was published in the International Journal of Gynecology and Obstetrics and was performed by a team of researchers from Chongqing Medical University, China. Dr. Xiao-yan Yi and colleagues found that women who underwent bariatric surgery had reduced risk of diabetes mellitus of pregnancy, high blood pressure and related disorders, and of having a large baby when compared with those obese women without surgery treatment.
Another study published in the same journal done by a French team of researchers from the Centre Hospitalier Departemental of La Roche sur Yon looked specifically into the effects of sleeve gastrectomy by laparoscopy in pregnancy. Dr. Guillaume Ducarme led this study of 54 patients and their pregnancies. There is a theoretical risk of adverse outcomes as result of low nutrient absorption following surgery, namely protein, iron, calcium, and vitamins A, D, K, and B12 deficiencies. Neveretheless, this study found no association between sleeve gastrectomy and adverse outcomes such as fetal growth restriction, malformations, and fetal anemia.
In conclusion, batriatric surgery in general and sleeve gastrectomy in particular remain the mainstay of therapy for obese patients who are unable to solve their disorder with diet and exercise alone. There is increasing evidence that sleeve gastrectomy is not only very efficacious, but also safe and is not associated with serious maternal or fetal (baby) adverse events. As a result, it is an option to be considered in patients looking to conceive as all women are advised to lose weight before getting pregnant to lessen the risk of serious pregnancy complications.