Pregnancy outcomes following bariatric surgery.

OBJECTIVE: To compare pregnancy outcomes postbariatric surgery for women who remain obese at conception to those who were not obese. METHODS: From a database of women who received outpatient perinatal services, we identified women with a history of bariatric surgery who are currently pregnant with a singleton gestation. Available maternal characteristics and pregnancy outcomes were compared between women whose prepregnancy body mass index (PPBMI) remained in the obese range (≥30 kg/m(2)) and those with a PPBMI of <30 kg/m(2) using Fisher exact test, independent Student's t test, and Mann-Whitney U test statistics. RESULTS: Of the 102 women identified, 52 (51%) were obese and 50 (49%) were not obese at conception. No differences were observed in maternal age, marital status, years from surgery to delivery, development of gestational diabetes, gestational age at delivery, neonatal intensive care unit (NICU) admission, or nursery days. Maternal obesity (≥30 kg/m(2)) postbariatric surgery was associated with higher rates of cesarean delivery (63.5% vs. 36.0%, p=0.010) and development of pregnancy-related hypertension (36.5% vs. 8.0%, p=0.001) compared to nonobese women (<30 kg/m(2)). CONCLUSIONS: Postbariatric surgery, an optimal goal should be to achieve a nonobese weight status before conception to reduce maternal complications, such as pregnancy-related hypertension and cesarean delivery.

New gestational weight gain guidelines: an observational study of pregnancy outcomes in obese women.

In 2009, the Institute of Medicine (IOM) revised their pregnancy weight gain guidelines, recommending gestational weight gain of 11-20 pounds for women with prepregnancy BMI >30 kg/m(2). We investigated the potential influence of the new guidelines on perinatal outcomes using a retrospective analysis (n = 691), comparing obese women who gained weight during pregnancy according to the new guidelines to those who gained weight according to traditional recommendations (25-35 pounds). We found no statistical difference between the two weight gain groups in infant birth weight, cesarean delivery rate, pregnancy-related hypertension, low birth weight infants, macrosomia, neonatal intensive care unit admissions, or total nursery days. Despite showing no evidence of other benefits, our data suggest that obese women who gain weight according to new IOM guidelines are no more likely to have low birth weight infants. In the absence of national consensus on appropriate gestational weight gain guidelines, our data provide useful data for clinicians when providing evidence-based weight gain goals for their obese patients.