Pregnancy after Gastric Band Surgery
Key points
- Laparoscopic Adjustable Gastric Band (LAGB) insertion is the primary surgical method of surgical weight reduction in the UK.
- LAGB insertion is increasing rapidly and the increase in gastric banding in women of reproductive age has resulted in increasing numbers of pregnancies following gastric banding.
- Management of pregnancy following gastric band surgery is not well defined.
- This study will use UKOSS to describe the epidemiology and management of gastric banding in pregnancy in the UK and use this information to develop future guidelines for optimal management.
Surveillance Period
November 2011 - October 2012
Background
The impact of obesity on pregnancy is well established; obesity negatively impacts on maternal, fetal and neonatal wellbeing[1]. Laparoscopic Adjustable Gastric Band (LAGB) insertion is the primary surgical method of surgical weight reduction in the UK. It involves application of an adjustable silicone balloon around the upper portion of the stomach, resulting in a small upper stomach pouch and a narrowed outlet, which limits the stomach's capacity to intake food and increases the feeling of fullness. These two effects assist subsequent weight loss. LAGB insertion is increasing rapidly both in the private sector and in the NHS, with an estimated 1,700 bands inserted in women under the age of 40 years in 2007. The increase in gastric banding in women of reproductive age has resulted in increasing numbers of pregnancies following gastric banding.
Nevertheless, management of pregnancy following gastric band surgery has not been well defined. In most reports, women who conceive following LAGB have the band deflated for the duration of the pregnancy[2] because of concerns regarding hyperemesis and poor nutritional intake. Deflating the gastric band has the adverse effect of excessive weight gain[3] and subsequent pregnancy complications. However, pregnancy following LAGB has been shown to be well tolerated and studies have also demonstrated a reduction in incidence of gestational diabetes[4][5][6], maternal hypertension 4-7 and caesarean delivery[7] when compared to obese controls.
Objectives
- To use the UK Obstetric Surveillance System to describe the epidemiology and management of gastric banding in pregnancy in the UK.
- To use this information to assess current practice and develop future guidelines for optimal management.
Research questions
- What is the incidence of pregnant women with previous gastric band surgery in the UK?
- How are women who are pregnant with a gastric band currently managed in the UK?
- What are the medical, obstetric and neonatal outcomes of pregnant women after gastric band surgery?
- What is the weight change in the pregnancies of women who have had gastric band surgery?
Case definition
Any woman with a confirmed ongoing pregnancy following laparoscopic adjustable gastric band surgery.
Funding
This study is funded by North Bristol NHS Trust.
Ethics committee approval
The study has been approved by the NRES Committee South West – Southmead (REC reference: 11/SW/0227).
Investigators
Elinor Medd, Judith Hyde, Mary Lynch, Andrew Johnson, Tim Draycott, Dimitrios Siassakos and Amanda Jefferys: Southmead Hospital, Bristol.
Download the Data Collection Form (DCF)
UKOSS Gastric banding in Pregnancy Form
References
- ^ Usha Kiran, T.S., et al., Outcome of pregnancy in a woman with an increased body mass index. BJOG, 2005. 112(6): p. 768-72.
- ^ Weiss, H.G., et al., Pregnancies after adjustable gastric banding. Obesity surgery, 2001. 11(3): p. 303-6.
- ^ Sheiner, E., et al., Pregnancy outcome in patients following different types of bariatric surgeries. Obesity surgery, 2009. 19(9): p. 1286-92.
- ^ Dixon, J.B., M.E. Dixon, and P.E. O'Brien, Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstetrics and Gynecology, 2005. 106(5 Pt 1): p. 965-72.
- ^ Ducarme, G., et al., Obstetric outcome following laparoscopic adjustable gastric banding. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2007. 98(3): p. 244-7.
- ^ Skull, A.J., et al., Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes. Obesity surgery, 2004. 14(2): p. 230-5.
- ^ Dixon, J.B., M.E. Dixon, and P.E. O'Brien, Pregnancy after Lap-Band surgery: management of the band to achieve healthy weight outcomes. Obesity surgery, 2001. 11(1): p. 59-65.
