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Infants who were born less than 2 years after a mother’s bariatric surgery had higher risks for prematurity, neonatal intensive care unit (NICU) admission, and small for gestational age status compared with longer intervals between bariatric surgery and childbirth, according to a study published online by JAMA Surgery.

Because bariatric operations can result in nutritional deficiencies in the mother, there has been some concern that surgery may adversely influence fetal development and infant outcomes. Although some preliminary studies have investigated these outcomes, conclusions are conflicting and limited by small sample sizes. In addition, a safe interval between bariatric surgery and childbirth remains undefined.

Brodie Parent, MD, University of Washington Medical Center, Seattle, Washington, and colleagues examined the association of bariatric surgery with subsequent perinatal outcomes and the operation-to-birth (OTB) interval with perinatal risks.

Data were collected from birth certificates and maternally-linked hospital discharge data from Washington State. Participants were mothers who had bariatric surgery prior to childbirth (postoperative mothers [POMs]) and their infants (n = 1,859) and a population-based random sample of mothers without operations (nonoperative mothers [NOMs]) and their infants matched by delivery year (n = 8,437).

A total of 10,296 individuals were included in the analyses. In the overall study group, the median age was 29 years. Compared with infants from NOMS, infants from POMs had a higher risk for prematurity (14% vs 8.6%), NICU admission (15% vs 11%), small for gestational age (SGA) status (13% vs 8.9%), and low Apgar score (18% vs 15%).

Compared with infants from mothers with more than a 4-year OTB interval, infants from mothers with less than a 2-year interval had higher risks for prematurity (12% vs 17%), NICU admission (12% vs 18%), and SGA status (9% vs 13%).

“This study underscores the higher risk status of this population and may indicate that a recently postoperative mother with underlying nutritional, metabolic, and physiological changes is at an elevated risk for perinatal complications,” the authors wrote. “These findings could help inform healthcare professionals and postoperative women of childbearing age about the optimal timing between bariatric surgery and conception.”

“Undoubtedly, bariatric operations result in many health benefits for morbidly obese women of childbearing age and reduce obesity-related obstetrical complications,” they added. “Findings from this study should not deter bariatric surgeons from offering such therapy to this population. Although we found evidence for some increased perinatal complications among POMs, our results indicate that these risks attenuate over time and approach the baseline population risk within 2 to 3 years. In other words, after 2 to 3 years, mothers appear to reap the benefits of a weight loss operation without increasing fetal risk.”

SOURCE: JAMA Surgery