Background: Obesity has reached epidemic levels at the global scale and is a leading cause of health-related disorders. Surgical weight reduction procedures are the last option for obese individuals but have become increasingly popular in recent years. While
obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are still being evaluated.
Objective: The aim of the present study was to evaluate the impact of bariatric surgery (BS) on maternal and neonatal health in the modern and rapidly developing health care system in Qatar.
Design: In this population-based retrospective study, the data obtained as a part of the PEARL-Peristat Study (Perinatal Neonatal Registry) conducted in the state of Qatar is analyzed. The PEARL-Peristat Study is an ongoing cohort study based on the predesigned
hospital data pertaining to mothers and their newborns. In its initial phase, the PEARL study was conducted from 2011 to 2013, while the phase discussed ion this work covered the 2017-2019 period.
Results: The population of interest for the present study comprised of 16,701 mothers who gave birth to 17,155 infants at > 22 weeks of gestation during a two year period in Qatar. However, only singleton deliveries (n = 16,248) were subjected to analyses.
Moreover, as the study focused on obese mothers, 1,918 women that were classified as obese formed the intervention group, while the remaining 14,015 women were treated as the control group. Among the obese mothers, 315 had bariatric surgery (BS), which
was on average performed at the age of 35 (59%). Majority of BS cases pertained to Qatari citizens (79%) and nulliparous women (21.6%). Compared to non-obese women, those that were classified as obese were statistically significantly more likely to deliver via
caesarean section (37.5% vs 30%, p = 0.003). In the group classified as obese, DM was noted in 23% cases, while PET, PIH, and PPH were respectively reported in 2.5%, 1.9%, and 5.9% of these patients, in line with the rates obtained for the control group. BS was
offered to 16 non-obese (12.9%) and 37 overweight (29.8%) women. No statistically significant differences were, however, noted between the intervention and the control group with respect to premature delivery (p = 0.12) and still birth (1.6% vs. 0.6%, p = 0.037), LBW (15% vs. 8.3%, p = 0.001), and Apgar score < 7 at fifth minute (1.3 % vs. 0.3%, p = 0.01). None of the newborns weighed above 4.5 kg. Comparison of obese women that underwent BS with those that did not revealed that the former group had a lower risk of
DM (77% vs. 53%), lower GDM (19% vs. 39%) and lower overt diabetes (3.55 vs. 6.75, p = 0.001). In addition, lower BMI at delivery was noted in this group (p = 0.001), as well as lower IOL rate, a greater number of LBW newborns (p = 0.001), and lower Apgar score
at 5th minute (p = 0.04). It is also noteworthy that BS was more likely to be offered to Qatari women than to non-Qatari patients (p = 0.001). On the other hand, no statistically significant differences were noted between these groups with respect to the likelihood of
premature delivery, PET, PIH, or PPH.
Conclusion: Obesity remains a major health problem worldwide. However, women that have undergone bariatric surgery are still exposed to multiple health risks, including delivering low birthweight infants having babies with lower Apgar score at fifth minute,
and having premature and stillborn babies. Nonetheless, BS appears to confer some desirable obstetric attributes, such as reduction in the incidence of IOL and assisted births. As bariatric surgery is a successful treatment of maternal obesity, more data is needed to determine clinical guidelines, given certain surgery-specific risks.
Keywords: Bariatric Surgery; Maternal; Obesity; Outcome; Newborn; Women