Pregnancy: wait at least 2 years after bariatric surgery

Bariatric surgeries are becoming more widespread in France. It especially affects women of childbearing age. A recent study reveals that it is preferable to wait at least 2 years after a bariatric surgery embark on a the pregnancy. In fact, the operation can have serious consequences on babies, if the delay is too short. explanations.

Bariatric surgery, increasingly widespread

Obesity surgeries, or bariatric surgeries, are used in cases of extreme obesity. They are experiencing rapid development in France with about 450,000 operations carried out between 2006 and 2017. These operations are reserved for people:

• With a body mass index (BMI) > 40 kg/m² or > 35 kg/m² in case of complications such as type 2 diabetes, hypertension or sleep apnea syndrome;
• Age between 18 and 60 years;
• Have no psychological contraindications;
• It does not present any particular operational risk.

Bariatric surgeries combine several operative techniques. They are performed under laparoscopy. These operations are not trivial and require good physical and psychological preparation:

• Restrictive surgical procedures that limit the ability to eat. Its objective is to reduce the volume likely to receive food. This may involve placement of an adjustable gastric band or partial removal of the stomach (Gastric band);
• Combined operations combine gastric restriction with the creation of a bypass of the digestive tract (derivation).

They are increasingly common in women of childbearing age. In fact, they reduce the risks associated with obesity during pregnancy, such as preeclampsia or gestational diabetes.

Impact of bariatric surgery on pregnancy

Doctors from the University Hospital of Coimbra in Portugal wanted to study The impact of bariatric surgery on pregnancy.. In particular, they investigated the effect of the time interval between bariatric surgery and pregnancy on the health of the newborn. To do this, they conducted a retrospective study of 48 pregnancies that occurred after bariatric surgery.

The women included in the study were on average 34.3 years old at the time of delivery. His average BMI was 30.9. These women underwent various types of bariatric surgery (gastric bypass, sleeve gastrectomy, gastric band, or biliopancreatic diversion). In addition, in 14.6% of the cases, delivery occurred before 12 months after surgery, in 14.6% of cases between 12 and 24 months later, and in 70.8% of deliveries. more than 2 years later.

The results of the study reveal that 26.3% of the children were born too small for their gestational age (PGA). Specifically, the period between surgery and conception was significantly shorter in PGA neonates. Furthermore, analyzes show that the longer a woman waits to conceive, the lower her risk of having a PGA baby. The authors estimate that each forecast month reduces this risk by 5%.

Wait 24.5 months after the operation

Thus, this study demonstrates that the optimal waiting period between bariatric surgery and the the pregnancy it is 24.5 months. There is then a 15 times greater risk of giving birth to a PGA baby. The risks for small-for-gestational-age babies are multiple. In fact, they can present at birth with hypothermia, hypoglycemia, infections, or neonatal asphyxia.

Therefore, respecting a time interval of 24.5 months between surgery and conception has a significant impact on the weight and health of the infant. In fact, a long interval allows women to stabilize their weight loss and nutritional status. Thus, the authors explain that the increased risk of PGA in the newborn could be related to the rapid weight loss of the mother after bariatric surgery. This would hinder the expected weight gain during pregnancy. Furthermore, this rapid weight loss would lead to nutritional deficiencies that could affect the health of the fetus.

Therefore, it is important that women undergoing bariatric surgery be aware of the risk of early conception and the benefits of delaying the pregnancy.

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