Discussion Questions

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  What were the aims of the study?

  
  
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  What was the authors’ overall approach?

  
  
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  What information was included in the tables?

  
  
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  Did this study have particular strengths or weaknesses?

  
  
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  Where should we go from here?

Introduction

Aside from consequences such as diabetes, hypertension, and cardiovascular disease, obesity is associated with higher rates of adverse pregnancy-related events, including gestational diabetes, preeclampsia, and infants with birth defects. Traditional weight-loss methods, such as dieting—with or without adjunctive medications—are not as effective as we would hope, generally providing poor long-term weight-loss results. Bariatric surgery techniques provide newer options, and it is clear that more women of reproductive age are opting for them. Data on reproductive outcomes in these women are becoming more available, and a new study by Josefsson and colleagues is another valuable addition to the literature.

George A. Macones, MD, MSCE, Associate Editor

Background

Macones: Thank you all for coming to discuss this interesting article on bariatric surgery and pregnancy by Josefsson and colleagues. How important is this subject?

Cahill: This is absolutely an important topic. Obesity is a worldwide epidemic, and the authors point out that the World Health Organization estimates at least 300 million adults worldwide are obese. This number is staggering, and we certainly see many obese pregnant women in St Louis.

Macones: I totally agree. I also thought the authors did a nice job reviewing what we know about obesity and treatments. Weight loss programs are marginally effective in the short term, and seem ineffective in the long term. In addition, pharmacologic treatment doesn’t seem like a useful long-term adjunct to diet for weight loss. So that leaves us with bariatric surgery as the only plausible longer-term solution.

Cahill: Yes, I agree with that. I believe in the early days, bariatric surgery wasn’t quite as safe as it is now. Many procedures are done laparoscopically, which is much safer and associated with a shorter hospital stay. I was interested to see that a vast majority of people who undergo bariatric surgery are women; almost 80%. That confirms my personal impression.

Macones: What were the overall aims of the study?

Stamilio: This study really had 2 aims. First, the authors wanted to look at factors associated with women who ultimately get bariatric surgery. The second aim was focused on broad obstetrical outcomes in women who underwent bariatric surgery.