Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data
Abstract
Objective
To determine whether women who had a delivery after bariatric surgery
have lower rates of hypertensive disorders in pregnancy compared with
women who had a delivery before bariatric surgery.
Design Retrospective cohort study.
Setting Claims data for 2002-6 from seven insurance plans in the United States.
Participants
585 women aged 16-45 who had undergone bariatric surgery, had at least
one pregnancy and delivery, and had continuous insurance coverage during
pregnancy plus two weeks after delivery.
Main outcome measure
Hypertensive disorders in pregnancy defined with ICD-9 codes. The
independent variable was the timing of delivery in relation to bariatric
surgery, classified as deliveries before and after surgery. We used
logistic regression to calculate odds ratios and confidence intervals
for each type of hypertensive disorder in pregnancy.
Results
Among the 585 women who had undergone bariatric surgery and had a
delivery, 269 delivered before surgery and 316 delivered after surgery.
Gastric bypass was the surgery in 82% (477) of all women. Women who
delivered before surgery were younger at the time of delivery (mean age
31.3 v 32.5) but had higher rates of pre-existing diabetes and
gestational diabetes mellitus. Compared with women who delivered before
surgery, women who delivered after surgery had substantially lower rates
of pre-eclampsia and eclampsia (odds ratio 0.20, 95% confidence
interval 0.09 to 0.44), chronic hypertension complicating pregnancy
(0.39, 0.20 to 0.74), and gestational hypertension (0.16, 0.07 to 0.37),
even after adjustment for age at delivery, multiple pregnancy (that is,
twins or more), surgical procedure, pre-existing diabetes, and
insurance plan.
Conclusion In this
retrospective analysis of US women, bariatric surgery was associated
with lower rates of hypertensive disorders in subsequent pregnancy.
Edited from bmj.com
#bariatric #pregnancy
