Pregnancy after bariatric surgery in women with rheumatic diseases and association with adverse birth outcomes

Namrata Singh; Rebecca J Baer; Maya Swaminathan; Shireesh Saurabh; Jeffrey A Sparks; Gretchen Bandoli; Elena Flowers; Laura L Jelliffe-Pawlowski; Kelli K Ryckman

doi:10.1016/j.soard.2020.09.016

Pregnancy after bariatric surgery in women with rheumatic diseases and association with adverse birth outcomes

Surg Obes Relat Dis. 2021 Feb;17(2):406-413. doi: 10.1016/j.soard.2020.09.016. Epub 2020 Sep 29.

Authors

Namrata Singh¹, Rebecca J Baer², Maya Swaminathan³, Shireesh Saurabh⁴, Jeffrey A Sparks⁵, Gretchen Bandoli⁶, Elena Flowers⁷, Laura L Jelliffe-Pawlowski⁸, Kelli K Ryckman⁹

Affiliations

¹ Division of Rheumatology, University of Washington, Seattle, Washington. Electronic address: nasingh@medicine.washington.edu.
² Department of Pediatrics, University of California, San Diego, La Jolla, California; California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.
³ General Internal Medicine, MultiCare Good Samaritan Hospital, Puyallup, Washington.
⁴ Department of Surgery, Kaiser Permanente Washington, Bellevue, Washington.
⁵ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
⁶ Department of Pediatrics, University of California, San Diego, La Jolla, California.
⁷ Department of Physiologic of Nursing and Institute for Human Genomics, University of California, San Francisco, California.
⁸ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
⁹ Department of Epidemiology, College of Public Health, Iowa City, Iowa.

PMID: 33097446
DOI: 10.1016/j.soard.2020.09.016

Abstract

Background: Autoimmune rheumatic diseases (ARDs) and bariatric surgery are each risk factors for adverse birth outcomes. To date, no study has investigated their combined impact on birth outcomes.

Objectives: The objective of this study was to evaluate the impact of bariatric surgery on pregnancy outcomes in women with an ARD. As a secondary comparison, we assessed the risk of bariatric surgery on the same outcomes in women without an ARD.

Setting: Records maintained by the California Office of Statewide Health Planning and Development.

Methods: This cohort study included infants born between 20-44 weeks of gestation in California between 2011-2018. Risks of adverse pregnancy outcomes were evaluated for women with a history of bariatric surgery as compared to women without a history of bariatric surgery, stratified by ARD, using log-linear regression with a Poisson distribution.

Results: The study included 3,574,165 infants, of whom 10,823 (0.3%) were born to women who had an ARD and 13,529 (0.38%) to women with a history of bariatric surgery. There were 155 infants born to women (0.0043%) with both an ARD and a history of bariatric surgery. In women with an ARD and without bariatric surgery, the prevalence of preterm births was 18%, compared to 17.4% in women with both ARD and bariatric surgery; in women without ARD but with prior bariatric surgery, the prevalence of preterm births was 13.7%, compared to 8.2% in women without bariatric surgery. Except for neonatal intensive care unit (NICU) admissions, women with an ARD and history of bariatric surgery were not at a statistically increased risk of having other adverse pregnancy outcomes as compared to women with an ARD and no history of bariatric surgery.

Conclusion: Our study shows that women with ARD already have a high occurrence of several adverse birth outcomes, and this was not further increased by a history of bariatric surgery. The infants born to women with a history of ARD and bariatric surgery were admitted to the NICU significantly more than the infants born to women with an ARD and no history of bariatric surgery.

Keywords: Autoimmune rheumatic diseases; Bariatric surgery; Pregnancy; Preterm birth.

MeSH terms

Bariatric Surgery* / adverse effects
Cohort Studies
Female
Humans
Infant
Infant, Newborn
Pregnancy
Pregnancy Outcome / epidemiology
Premature Birth* / epidemiology
Premature Birth* / etiology
Rheumatic Diseases* / epidemiology