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Maternal and Perinatal Outcomes After Laparoscopic Sleeve Gastrectomy

Rottenstreich, Amihai, MD; Elchalal, Uriel, MD; Kleinstern, Geffen, PhD; Beglaibter, Nahum, MD; Khalaileh, Abed, MD, PhD; Elazary, Ram, MD

doi: 10.1097/AOG.0000000000002481
Contents: Original Research
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OBJECTIVE: To examine associations of laparoscopic sleeve gastrectomy with maternal and perinatal outcomes.

METHODS: We conducted a retrospective case–control study of deliveries that occurred from 2006 to 2016 at two university hospitals. The study group comprised all women who had undergone laparoscopic sleeve gastrectomy and who delivered during the study period. If a woman had more than one pregnancy during the study period, data from only her first pregnancy were used. A control group was established by matching preoperative body mass index (BMI), age, parity, delivery history, and delivery year.

RESULTS: Data from 238 women were analyzed, 119 post–laparoscopic sleeve gastrectomy and 119 matched control parturients. Among the post–laparoscopic sleeve gastrectomy patients, the median preoperative BMI was 41.7 (interquartile range 39.9–44.4) and the median postoperative BMI was 28.9 (26.6–32.0). Compared with the control group, the study group had lower rates of gestational diabetes mellitus (3.4% vs 17.6%, P=.001), large-for-gestational-age neonates (1.7% vs 19.3%, P=.001), and birth weight greater than 4,000 g (0.8% vs 7.6%, P=.02) but higher proportions of small-for-gestational-age (SGA) neonates (14.3% vs 4.2%, P=.01) and low-birth-weight neonates (12.6% vs 4.2%, P=.03). Rates of gestational hypertensive disorders and prematurity were comparable between the groups. For the study group, hemoglobin levels were lower in early pregnancy (median 12.6 vs 13.2 g/dL, P=.001) and after delivery (10.5 vs 10.8 g/dL, P=.002), and a higher proportion of patients were treated with intravenous iron supplementation during pregnancy (14.3% vs 0.8%, P=.001). Cesarean delivery rates during labor were lower in the study group (10.1% vs 20.2%, P=.04).

CONCLUSION: Laparoscopic sleeve gastrectomy was associated with reduced rates of gestational diabetes mellitus, excessive fetal growth, and cesarean delivery and an increased rate of SGA and low-birth-weight neonates.

Laparoscopic sleeve gastrectomy is associated with reduced rates of gestational diabetes mellitus, excessive fetal growth, and cesarean delivery but increased rates of small-for-gestational-age and low-birth-weight neonates.

Departments of Obstetrics and Gynecology and Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and the Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.

Corresponding author: Uriel Elchalal, MD, Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem, Israel 91120; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Ms. Cindy Cohen for editorial assistance.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.