Weight-loss surgery lowers birth defects risk

Severe obesity raises particular travel health issues

NEW YORK, Oct 16, (RTRS): Women with severe obesity who have gastric bypass surgery to lose weight before becoming pregnant may be less likely to have babies with birth defects than similar women who don’t have weight-loss surgery, a new study suggests.

As reported in JAMA, researchers examined data on more than 33,000 women with a history of severe obesity who gave birth, including 2,921 who had gastric bypass surgery and lost weight before conception. Overall, 3.4% of women who had surgery had babies with major birth defects, compared with 4.9% of women who didn’t have weight-loss operations. Changes in weight and blood sugar may explain these results, said lead study author Martin Neovius, from the Karolinska Institute in Stockholm.

“Both obesity and poorly controlled blood sugar are associated with increased risk of birth defects in a dose-dependent manner,” Neovius said by email. “This means that the more obese you are, the greater the risk of birth defects, and the worse blood glucose control, the greater the risk of birth defects.”

In the surgery group, women started out with an average body mass index (BMI) of 43.5 and an average weight of 122 kilograms (269 pounds). After surgery, their average body weight was 82 kilograms (181 pounds) prior to conception. Before gastric bypass surgery, 9.7% of the women in that group had been taking prescription diabetes drugs to lower their blood sugar. But in the six months prior to conception, only 1.5% of them took diabetes drugs.

Improvements

“These improvements may be the mechanism behind the observed lower risk of birth defects,” Neovius said.

Major heart defects accounted for 60% of the birth defects among mothers who underwent gastric bypass procedures. No babies in this group had neural tube defects, while there were 20 cases of neural tube defects among women who didn’t have surgery. For the study, researchers examined data on singleton births in Sweden from 2007 to 2014.

All of the weight-loss surgeries were procedures known as Roux-en-Y gastric bypass, in which surgeons divide the stomach to create a small pouch about the size of an egg. Then, surgeons connect the pouch to the end of the small intestine, so that food travels directly there, bypassing the stomach and the first portion of the small intestine.

One limitation of the study is that it only included data on live births, not miscarriages or pregnancy terminations or stillbirths. It’s possible the results might underestimate birth defects by excluding these pregnancies, at least some of which might have ended because babies had birth defects too severe to survive. Obesity can contribute to infertility, noted Dr Brian Smith, co-director of the minimally invasive surgery fellowship at UC Irvine Health and chief of surgery at the VA Long Beach Healthcare System.

International travelers who are obese may face difficulties with flights, hotel access and certain leisure activities, say researchers who suggest the travel industry and travel health specialists should address these issues.

Based on interviews with severely obese men and women about their experiences with international travel, the small study found that airport facilities and procedures, physical discomfort and embarrassment on flights, and limitations associated with obesity were recurring themes, according to the report in the Journal of Travel Medicine.

“Obesity is a common condition and we know that obese individuals are subject to physical restrictions and weight bias in their everyday lives,” said lead author Dr Gerard Flaherty of the School of Medicine at the National University of Ireland Galway.

“There is a dearth of research relating to the actual travel experiences of travelers with chronic medical illness, how their underlying conditions impact their travel or how travel affects the management of their pre-existing illness,” he told Reuters Health by email. Flaherty and colleagues interviewed 12 patients who were attending a bariatric lifestyle modification program in Ireland. Most were in their 50s and each had a body mass index in the “obese” or “severely obese” category.