D0614 - Prior Bariatric Surgery and Labor/Delivery and Pregnancy Complications

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Shahroz Fatima, MD

NYU Langone
New York, NY

Shahroz Fatima, MD¹, Violeta Popov, MD, PhD, FACG²
¹NYU Langone, New York, NY; ²NYU Langone Health, New York, NY

Introduction: As rates of obesity rise, the incidence of bariatric surgery (BaS) has increased. Included amongst these patients are women with plans for pregnancy and labor and delivery (L&D). Bariatric surgery has been shown to improve menstrual irregularities and conception rates; but there is limited data on its effects on pregnancy and L&D outcomes.

Methods: A retrospective cohort analysis of the 2012 Nationwide Inpatient Sample (NIS) database. Inclusion criteria were ICD-9 codes for pregnancy and L&D. Exposure of interest was ICD-9 code for history of BaS. Primary outcomes were pregnancy and L&D complications in women with BaS compared to women without BaS with and without obesity. Secondary outcomes were length of stay (LOS) and hospitalization cost. Differences between cases and controls were compared with student t-test and chi-square tests; multivariable logistic regression was used to control for confounders.

Results: A total of 8,185 inpatient admissions of pregnant subjects with BaS were captured in the 2012 NIS with 212,945 admissions of pregnant women with obesity without BaS and 211,155 admissions of pregnant women without obesity or BaS. A total of 3,608,876 deliveries were captured in the United States in 2012 with 9,159 with history of BaS. Patients with prior BaS were older (33 vs. 28 years, p< 0.01), had longer mean LOS (3.3 vs. 2.6/2.8 days, p< 0.01), and higher cost (18,945 vs. 15,071 USD, p< 0.01; 19,107 vs. 14,971 USD, p< 0.01). Pregnancy complications like gestational diabetes, hypertension, pre-eclampsia were more common in the BaS cohort than the general cohort, but lower than the cohort with obesity. Alcohol and mental health disorders, hyperemesis, spontaneous abortions, and thromboembolism were more common in pregnant women with BaS compared with both other cohorts (Table 1a). The rate of cesarean and breech delivery, fetal distress, anesthesia complication, ectopic pregnancy, and infection was higher in women with BaS compared to those without (Table 1b). Bariatric surgery remained a significant predictor for cesarean delivery and longer LOS after controlling for age.

Discussion: Pregnant women with history of bariatric surgery have increased risk of pregnancy and L&D complications and should be considered high-risk pregnancies and deliveries as the rate of potential complications is higher compared to those without prior bariatric surgery, including when compared to pregnant women with obesity.

A. Diagnosis-Pregnancy	Post-Bariatric Surgery, % (95% CI)	Controls (no obesity), % (95% CI)	P₁	Controls (with obesity), % (95% CI)	P₂
Total charges per admission, USD	19,107	14,971	< 0.001	19,148	0.9
Mean age, years	33	28	< 0.001	28.5	< 0.001
Length of stay, days	3.33	2.8	< 0.001	3.27	0.4
Hypertension	8.4 (7.0. 9.7)	4.4 (4.2, 4.6)	< 0.001	12.4 (12, 12.7)	< 0.001
Diabetes	4.8 (3.7, 6.0)	1.4 (1.3,1.5)	< 0.001	5.5 (5.3, 5.7)	0.2
Gestational diabetes	9.3 (7.9. 11)	6.3 (6.0,6.5)	< 0.001	16.4 (16, 16.8)	< 0.001
Mental antepartum	3.2 (2.3, 4.0)	1.1 (0.9, 1.2)	< 0.001	1.0 (0.9, 1.1)	< 0.001
Mental health disorders	15.4 (14,17)	10 (10.11)	< 0.001	9.6 (9.3,9.9)	< 0.001
Alcohol dependence	3.2 (2.3, 4.0)	1.4 (1.3, 1.5)	< 0.001	1.1 (1.0, 1.2)	< 0.001
Liver disease in pregnancy	0.6 (0.2, 1.0)	6.4 (5.6, 7.1)	0.9	0.5 (0.5, 0.6)	0.7
Spontaneous or missed abortions	1.0 (0.5, 1.5)	0.6 (0.5, 0.6)	0.04	0.4 (0.3, 0.5)	< 0.001
Thromboembolic complications	1.2 (0.7, 1.8)	0.6 (0.5, 0.7)	< 0.001	0.7 (0.7, 0.8)	0.03
Hyperemesis	2.6 (1.8, 3.3)	0.7(0.6, 0.8)	< 0.001	0.8 (0.7, 0.9)	< 0.001
Severe pre-eclampsia	1.8 (1.1,2,5)	1.9 (1.8,2.1)	0.08	3.3 (3.2, 3.5)	0.001
Pre-eclampsia	8.4 (7.0, 9.7)	4.4 (4.1, 4.6)	< 0.001	12.4 (12, 13)	< 0.001
Nutritional deficiencies	41(38, 43)	30 (29, 30)	< 0.001	39 (38, 40)	0.2
B. Diagnosis- L&D	Post-Bariatric Surgery,% (95% CI)	Controls (no obesity),% (95% CI)	P
Total charges per admission, USD	18,945	15,071	< 0.001
Mean age, years	33	28	< 0.001
Length of stay, days	3.3	2.6	< 0.001
C-section	46 (44,49)	32 (31,32)	< 0.001
Breech delivery	1.5 (1.0,2.1)	1.0 (0.9,1.0)	0.001
Assisted vaginal delivery (forceps, others)	51 (49, 53)	65 (65.1, 65.4)	< 0.001
Anesthesia complications	0.7 (0.3, 1.0)	0.3 (0.3, 0.3)	0.02
Placenta previa	2.7 (1,9,3.4)	1.9 (1.8,1.9)	0.01
Fetal distress	47.4 (45,50)	26 (25.8,26)	< 0.001
Puerperium, infections	1.9 (1.3,2.5)	0.8 (0.8,0.9)	< 0.001
Ectopic pregnancies	0.5 (0.2,0.8)	0.1 (0.1, 0.1)	< 0.001
Bleeding after delivery	2.3 (1.6, 3)	3.0 (2.9, 3.0)	0.12
Spontaneous or missed abortions	0.65 (0.3, 1.0)	0.12 (0.1, 0.9)	< 0.001
Thromboembolic complications, puerperium	0.9 (0.4, 1.3)	0.56 (0.54, 0.58)	0.07
Retained placenta	0.4 (0.1, 0.7)	0.5 (0.5, 0.5)	0.8
Disproportion, fetal	1.4 (0.8,1.8)	1.7 (1.6,1.7)	0.3
Early membrane rupture	8.6 (7.3, 9.9)	8.7 (8.7,8.8)	0.8

Table: Table 1A. Common pregnancy complications in pregnant women with prior bariatric surgery compared with pregnant women without obesity and with pregnant women with obesity. 95%CI, 95% confidence interval. Significant comparisons in bold. P1 value refers to the comparison between the post-bariatric cohort and the general cohort without obesity, and P 2 for comparison between the post-bariatric cohort and the cohort with obesity.

Table 1b. Common labor and delivery complications in cases (pregnant women with prior bariatric surgery) and controls (pregnant women, no bariatric surgery, no obesity). 95%CI, 95% confidence interval. Significant comparisons in bold. P value reported for the comparison between the post-bariatric cohort and the cohort without obesity.

Disclosures:

Shahroz Fatima indicated no relevant financial relationships.

Violeta Popov indicated no relevant financial relationships.

Shahroz Fatima, MD¹, Violeta Popov, MD, PhD, FACG². D0614 - Prior Bariatric Surgery and Labor/Delivery and Pregnancy Complications, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.

D0614 - Prior Bariatric Surgery and Labor/Delivery and Pregnancy Complications

Presenting Author(s)

A. Diagnosis-Pregnancy

Post-Bariatric Surgery, % (95% CI)

Controls (no obesity), % (95% CI)

P1

Controls (with obesity), % (95% CI)

P2

B. Diagnosis- L&D

Post-Bariatric Surgery,% (95% CI)

Controls (no obesity),% (95% CI)

P

P₁

P₂