Table 1.
Summary of descriptive characteristics of included studies and reported associations between bariatric surgery and risk of birth defects.
| Reference Scorea | Location, Data Sources, and Study Details | Procedure(s) (Years)b | Outcome Assessment | BSurg # BD/total (%)c | Comparison # BD/total (%)c | OR or RR (95% CI)d | Variable used in Matching (MV) and Adjustment (AV) | |
|---|---|---|---|---|---|---|---|---|
|
Any Bariatric Surgery | ||||||||
| Sheiner et al. 200431,e 4 |
Southern Israel Soroka University Medical Center perinatal database Population-based birth cohort, 1988-2002 Compared births to women with and without prior BSurg |
Restrictive and malabsorptive | Reported by obstetrician | 15/298 (5.0) | 6,333/158,912 (4.0) | uOR 1.28f (0.76, 2.15) | MV: None AV: None |
|
| Weintraub et al. 200832,e 6 |
Southern Israel Soroka University Medical Center perinatal database Population-based sample of singleton deliveries, 1988-2006, to women who had BSurg Compared births before and after Bsurg |
Restrictive and malabsorptive | Reported by obstetrician | 40/507 (7.9) | 10/301 (3.3) | aOR 1.90 (0.88, 4.12) | MV: None AV: Age; Preterm delivery |
|
| Josefsson et al. 201344,g 8 |
Sweden Medical Birth, Total Population, National Patient and Birth Defects Registries Population-based, nested case-control study of first live born children, with birth dates before 2010, to women born 1973-1983 Compared infants with and without birth defects |
Gastroplasty, gastric banding and gastric bypass | Swedish Register of Birth Defectsh | 13/318 (4.1) | 8,282/244,294 (3.4) | aOR 1.09 (0.63, 1.91) | MV: None AV: Early pregnancy BMI; Age; Diabetes; HTN/Preeclampsia; Marital status; Smoking |
|
| Abenhaim et al. 201635 6 |
USA Health Care Costs and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) Birth cohort, 2003-2011 Compared births to women with prior Bsurg and obese (BMI>40 kg/m2 at delivery) women without BSurg |
Specific procedures not provided | HCUP-NIS database | 47/9,587 (0.5) | 1,196/221,580 (0.5) | aOR 0.74 (0.52, 1.04) | MV: None AV: Age; Cardiovascular disease; Diabetes; Hospital type; HTN; Income; Insurance type; Pulmonary disease; Race; Renal disease |
|
| Parent et al. 201736 7 |
Washington, USA Birth certificates and linked maternal discharge data from prior hospitalizations Population-based birth cohort, 1980-2013 Compared births to women with and without prior BSurg |
Banded gastroplasty, adjustable gastric band, sleeve gastrectomy and RYGB | Birth certificate and discharge diagnosis codesi | 403/1,859 (21.7) | 1,359/8,437 (16.1) | aRR 1.12 (0.99, 1.26) | MV: None AV: Prepregnancy BMI; Age; Birth year; Diabetes; Education; Household income; HTN; Parity; Race/Ethnicity |
|
|
Gastric Bypass | ||||||||
| Martin et al. 198830 4 |
Iowa, USA Self-administered questionnaire Patients of 4 bariatric surgeons Compared NTDs in pregnancies before and after BSurg |
Specific procedures not provided | Maternal report on questionnairej | 2/110 (1.8) NTDs only |
0/73 (0.0) | -- | MV: None AV: Not relevant |
|
| Wittgrove et al. 199837 5 |
California, USA Patient interviews and medical records Patients from one surgical group Compared pregnancies before and after BSurg |
Predominantly RYGB | Maternal report during interview | NR/36 | NR/23 | No increased risk of congenital anomalies | MV: None AV: Not relevant |
|
| Patel et al. 200839 6 |
Pennsylvania, USA Birth logs Women delivering at a single hospital, 2003-2006 Compared births to women with prior BSurg and 3 groups of women without BSurg: Non-obese (BMI <30 kg/m2); Obese (BMI 30-39.9 kg/m2) with no serious co-morbidities; and Morbidly or seriously obese with (BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with serious co-morbidities) |
RYGB | Not specified | 0/26 (0.0) | Non-obese: 2/188 1.1) Obese: 2/39 (5.1) Morbidly obese: 1/27 (3.7) |
-- |
MV: None AV: Not relevant |
|
| Wax et al. 200840 5 |
Maine, USA Data sources not specified Women delivering in a single maternal-fetal medicine unit Compared births to women with and without prior Bsurg |
RYGB | Not specified | 0/38 (0.0) | 4/76 (5.1) | -- | MV: Maternal age (<35 or ≥35 years); Prior cesarean AV: Not relevant |
|
| Santulli et al. 201042 6 |
France Louis Mourier Hospital’s database All births, 2004-2010, following Bsurg at a single institution and all deliveries at the same institution Compared births to women with prior BSurg to 2 groups of women without BSurg: normal BMI (18.5-24.9 kg/m2 ); and matched on prepregnancy BMI |
RYGB |
Not specified | NR/24 | Normal BMI: NR/120 BMI-matched: NR/120 |
No cases of birth defect | MV: Age; Parity AV: Not relevant MV: Prepregnancy BMI; Age; Parity AV: Not relevant |
|
| Berlac et al. 201433 6 |
Denmark National Health and National Birth Registries Population-based cohort Compared singleton births to women with prior BSurg and 2 groups of women without BSurg: normal BMI (20-24 kg/m2); and matched on prepregnancy BMI |
RYGB (1996-2011) | National Birth Registry | 30/413 (7.3) | Normal BMI: 44/827 (5.3) BMI-matched: 52/823 (6.3) |
uOR 1.39f (0.86, 2.25) uOR 1.16f (0.73, 1.85) |
MV: Age; Parity; Plurality; Year of delivery AV: None MV: Prepregnancy BMI; Age; Parity; Plurality; Year of delivery AV: None |
|
| Adams et al. 201543 6 |
Utah, USA Utah Population Database and birth certificates Women who had BSurg in a single surgical practice were linked to births after 1988 Compared births to women with prior BSurg and obese women without BSurg |
RYGB (1979-2011) | Birth certificates | 15/295 (5.1) | 12/295 (4.1) | uOR 1.26f (0.58, 2.74) | MV: Prepregnancy BMI prior to surgery; Age; Birth order; Parity; Race, Year of delivery AV: None |
|
| Johansson et al. 201534,g 7 |
Sweden Medical Birth, National Patient and Scandinavian Obesity Surgery Registries Population-based sample of singleton births, 2006-2011 Compared births to women with prior Bsurg to a matched group of women without Bsurg |
Predominantly RYGBk (2004-2011) | Medical Birth Registryl | All women (excluding chromosomal abnormalities): | MV: Pre-surgery BMI/Early pregnancy BMI; Age; Education; Parity; Smoking; Year of delivery AV: History of coexisting conditions; History of substance abuse; Mother’s country of birth |
|||
| 12/590 (2.0) | 79/2,334 (3.4) | aOR 0.63 (0.34, 1.18) | ||||||
| Restricted to one birth per women (excluding chromosomal abnormalities): | ||||||||
| 11/549 (2.0) | 67/2,110 (3.2) | aOR 0.68 (0.35, 1.31) | ||||||
|
Laparoscopic Adjustable Gastric Band (LAGB) | ||||||||
| Lapolla et al. 201041 5 |
Italy Databases of the Obesity Centers at Vicenza Regional Hospital and Padova University, phone interviews, and electronic database Compared pregnancies before and after BSurg and compared pregnancies to women with prior Bsurg to 2 groups of women without BSurg: BMI ≥ 40 kg/m2 and no diabetes or chronic hypertension; normal weight without gestational diabetes |
LAGB (1993-2005) | Maternal report and electronic database | NR/83 | Pre-surgery: NR/27 BMI≥40: NR/120 Normal: NR/858 |
No birth defects identified | MV: None AV: Not relevant |
|
|
Biliopancreatic Diversion (BPD) | ||||||||
| Marceau et al. 200438 5 |
Canada Laval Hospital Questionnaire Compared births before and after Bsurg |
BPD (1984-2000) | Maternal report | 7/167 (4.2) | 33/1,257 (2.6) | uOR 1.62f (0.71, 3.73) | MV: None AV: None |
|
Abbreviations: AV, variables used to derive adjusted effect estimates; BD, birth defects; BMI, body mass index; BPD, biliopancreatic diversion; Bsurg, bariatric surgery; CI, confidence interval; HTN, hypertension; ICD, International Classification of Diseases; LAGB, Laparoscopic adjustable gastric band; MV, variables used for matching; NR, not reported; NTDs, neural tube defects; RYGB, Roux-en-Y gastric bypass; uOR/aOR, unadjusted/adjusted odds ratio; uRR/aRR, unadjusted/adjusted rate ratio
The Newcastle-Ottawa Scale (NOS) score is out of a possible 8 for all studies except Josefsson, which is out of a possible 9 because it is a case control study
Years during which the bariatric procedures were performed, if specified in the article.
If counts were not provided, they were calculated from provided percentage.
Effect estimates were not calculated when 0 birth defects were reported in one or more groups. When specific birth defect counts were not specified in the article, a summary of the authors’ comments regarding the frequency of birth defects is provided.
There is likely to be overlap between the bariatric surgery cases included in Sheiner et al. 2004 and Weintraub et al. 2008. However, the two studies used different comparison groups.
uOR calculated from data provided in the article.
There is likely to be overlap between the study populations included in Josefsson et al. 2013 and Johansson et al. 2015.
Included ICD-10 codes starting with Q and ICD-9 codes 740.0-759.9.
Included ICD-9 codes 740-756.
Affected offspring verified by medical record review.
98% of procedures were gastric bypass, 2% were gastric banding, and 1% were another type of bariatric surgery.
ICD-10 codes for major non-chromosomal malformations.