Bariatric surgery helped reduce the risk for birth defects in children born to women with severe obesity, a Swedish study found.
Women who underwent Roux-en-Y gastric bypass surgery prior to pregnancy had a 33% lower risk of having a child with a major birth defect vs women who didn't undergo metabolic surgery (risk ratio 0.67, 95% CI 0.52-0.87, P=0.002), Martin Neovius, PhD, of the Karolinska Institutet in Stockholm, and colleagues reported in a research letter in JAMA.
This reduced birth defect risk held significant in two sensitivity analyses looking only at birth defects that didn't include chromosomal abnormalities, as well as first births succeeding bariatric surgery (P≤0.001 for both), as follows:
- Excluding chromosomal abnormalities: RR 0.66 (95% CI 0.51-0.85)
- First birth after surgery: RR 0.58 (95% CI 0.44-0.77)
Roughly 60% of birth defects born to mothers after bariatric surgery included major heart defects. However, there were no neural tube defects among the babies born post-surgery. The researchers noted that this clinically relevant finding was important, as one of the major concerns for women giving birth after bariatric surgery is a potential risk of neural tube defects due to folate deficiency.
"If the observed association is true, a mechanism could be that surgery induced improvements in glucose metabolism, and potentially other beneficial physiologic changes, led to a reduction of major birth defect risk to a level similar to that of the general population (3.5%)," Neovius and co-authors wrote.
In a statement, Neovius added that the findings "should help reduce fears that bariatric surgery increases the risk of birth defects in the event of future pregnancy, assuming that surgery patients take their recommended nutritional supplements."
Drawing upon the Scandinavian Obesity Surgery Register, the cohort study matched nearly 3,000 singleton births from 2007 to 2014 based upon year of delivery, pre-surgery body mass index (BMI) and diabetes status, birth defects in prior pregnancies, along with other maternal clinical characteristics including age, smoking, alcohol and substance use, parity, use of psychiatric drugs, and the current number of prescription drugs. There was an average 1.6-year interval between the time of bariatric surgery to the time of conception.
About 25% of the women in both maternal groups had BMI values of 35-39.9, while the majority were in the range of 40-44.9. About 20% of both groups had a BMI of 45-49.9, while in 12% the BMI was 50 or greater. Nearly 10% of both maternal groups had diabetes at baseline, and 30% were currently prescribed a psychiatric drug.
Women who underwent Roux-en-Y gastric bypass surgery during the years of the study had an average weight loss of 88 lb (40 kg), dropping the average body weight from 269 lb (122 kg) down to 181 lb (82 kg). During the 6 months prior to conception, the use of diabetes drugs dropped from 9.7% down to 1.5% after bariatric surgery, the researchers reported.
Overall, there were 4.9% identified major birth defects in babies born to mothers with obesity vs 3.4% in babies born to mothers who had previously undergone gastric bypass.
Study co-author Olof Stephansson, MD, PhD, also of the Karolinska Institutet, said in a statement that despite the positive associations seen between bariatric surgery and the reduced risk for birth defects, it is important to keep in mind that women who have undergone bariatric surgery will need special antenatal care throughout their pregnancy: "[This includes] additional ultrasounds to monitor fetal growth and detailed nutritional counseling that include administration of supplements necessary after weight-loss surgery," he said.
"Antenatal care providers should also check for nutrition deficiencies in addition to iron, such as folic acid, calcium, and vitamin B12," Stephansson added.
Study limitations, the researchers said, included that there was a lack of data on both stillbirths and terminated pregnancies.
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the U.S. National Institutes of Health, the Swedish Research Council, and the Swedish Research Council for Health, Working Life, and Welfare, with additional support for the researchers from the Strategic Research Area Epidemiology program at the Karolinska Institute and the Swedish Research Council.
Neovius reported relationships with Itrim and Ethicon Johnson & Johnson; other study authors also reported relationships with industry.
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