Abstract
Objective
To systematically investigate a wide range of obstetrical and neonatal outcomes in
respect to two types of pre-pregnancy bariatric surgery: Roux-en-Y gastric bypass
(RYGB) and sleeve gastrectomy (SG) through 1. providing a meta-analysis of the effect
of bariatric surgery (RYGB vs no surgery and, separately, SG vs no surgery) on adverse
obstetric and neonatal outcomes, and 2) to compare the relative benefit of RGYB vs.
SG using both conventional meta-analysis and network meta-analysis.
Data sources
We searched PubMed, Scopus, and Embase systematically from inception up to April 30,
2021
Study eligibility criteria
Studies reporting on pregnancies’ obstetrical and neonatal outcomes in respect to
two types of pre-pregnancy bariatric surgery including RYGB and SG. Included studies
either indirectly compared between the procedure and control or directly compared
between the two procedures.
Methods
We performed a systematic review followed by pairwise and network meta-analysis (NMA)
in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. In the pairwise analysis, multiple obstetrical and neonatal outcomes were
tabulated and compared between three types of groups 1) RYGB vs controls, 2) SG vs controls, and 3) RYGB vs SG. Primary outcomes included small for gestational age (SGA), large for gestational
age (LGA), gestational hypertension (GHTN)/preeclampsia (PE), and gestational diabetes
(GDM). Secondary outcomes included preterm birth (PTB), anemia, cesarean delivery
(CD), and biochemical profile. The random-effect model was used to pool the mean differences
or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Heterogeneity
was assessed using the I2 value. Newcastle Ottawa Scale (NOS) was used to assess individual study quality.
To resolve inconclusive findings and to rank current treatments, NMA was conducted
for the primary outcomes. Quality of the evidence was assessed with the Confidence
in NMA approach and Grading of Recommendations, Assessment, Development and Evaluations
tool within the summary of findings table.
Results
Total of 20 studies were included reporting on 40,108 pregnancies of which 5,194 underwent
RYGB, 405 underwent SG, and 34,509 were controls. Compared to controls, RYGB increased
SGA infants (OR: 2.56 (95% CI 1.77, 3.70), I2 29.1%, P<<0.00001), decreased LGA (OR: 0.25 (95% CI 0.18, 0.35), I2 0%, P<0.00001), decreased GHTN/PE (OR: 0.54 (95% CI 0.30, 0.97), I2 26.8%, P=0.04), decreased GDM (OR: 0.43 (95% CI 0.23, 0.81), I2 32%, P=0.008), increased maternal anemia (OR: 2.70 (95% CI 1.53, 4.79), I2 40.5%, P<0.001), increased NICU admission (OR: 1.36 (95% CI 1.04, 1.77), I2 0%, P=0.02), and lower mean gestational weight gain (GWG) (Mean difference: -3.37
kg (95% CI -5.62, -1.11), I2 65.3%, P=0.003). Only 3 studies compared SG to control with no significant differences
in primary outcomes or in mean GWG. The NMA showed that RYGB (malabsorptive procedure)
resulted in greater decrease of LGA, GHTN/PE, and GDM and a greater increase in SGA
infants when compared to SG (restrictive procedure). However, small number of studies,
small number of SG patients, limited outcomes, and data heterogenicity resulted in
low-to-moderate network GRADE of evidence.
Conclusion
This NMA showed that RYGB resulted in greater decrease in LGA, GHTN/PE, and GDM compared
to SG, but at the same time it resulted in greater increase SGA infants. Certainty
of evidence was low-to-moderate network GRADE of evidence. Evidence is still lacking
for periconception biochemical profile, congenital malformations, and reproductive
health outcomes between both interventions; thus, future well-designed prospective
studies are needed to further characterize these outcomes.
Keywords
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Article info
Publication history
Accepted:
February 28,
2023
Received in revised form:
February 13,
2023
Received:
October 13,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
The systematic review is registered in PROSPERO (Registration number: CRD42021276955).
No external funding has been received for this study.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
