P1164 - Impact of Prior Bariatric Surgery on Pregnancy Outcomes: A Retrospective Nationwide Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

BP

Bhanu Siva Mohan Pinnam, MD (he/him/his)

John H. Stroger, Jr. Hospital of Cook County
Chicago, IL

Bhanu Siva Mohan Pinnam, MD¹, Violeta Popov, MD, PhD², Shahroz Fatima, MD²
¹John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ²NYU Langone Health, New York, NY

Introduction: Bariatric surgery has become an increasingly popular treatment option for patients with obesity. As the prevalence of obesity continues to rise worldwide, so does the number of women of reproductive age seeking bariatric surgery. Despite studies assessing the effect of bariatric surgery on multiple aspects of healthcare, its association with pregnancy complications remains understudied. Hence, we aimed to compare pregnancy-associated complications in those with and without a history of bariatric surgery.

Methods: The National Inpatient Sample (NIS) for the year 2020 was queried using International Classification of Diseases, Tenth Revision (ICD-10) codes to identify all pregnant admissions. These were further stratified into those with a history of bariatric surgery (BAS) (cases) and those without BAS (controls). These controls were further split into obese and non-obese controls. Multivariate logistic regression was used to compare the odds of complications and adverse outcomes while adjusting for potential confounders. Length of stay (LOS) and total hospitalization charges (THC) were compared using linear regression analysis.

Results: 2,640,990 pregnant admissions were identified, of which 5,990 had a history of bariatric surgery, 510,130 were obese controls (OC), and 2,124,870 were non-obese controls (NOC). The BAS group had a higher Charlson Comorbidities Index and higher rates of miscarriages [BAS vs. OC: odds ratio (OR) 3.28, 95% confidence interval (CI) 1.95-5.5, p< 0.001, and OR 1.5, 95% CI 0.91-2.46, p=0.105], alcohol dependence [BAS vs. OC: OR 3.45, 95% CI 1.79-6.6, p< 0.001 and BAS vs. NOC: OR 2.45, 95% CI 1.3-4.61, p=0.005], mental health disorders [BAS vs. OC: OR 1.71, 95% CI 1.48-1.96, p=0.001 and BAS vs. NOC: OR 2.65, 95% CI 2.31-3.05, p< 0.001], hyperemesis [BAS vs. OC: OR 6.25, 95% CI 4.46-8.81, p< 0.001 and BAS vs. NOC: OR 3.04, 95% CI 2.18-4.24, p< 0.001], and nutritional deficiencies [BAS vs. OC: OR 2.85, 95% CI 2.03-4, p< 0.001 and BAS vs. NOC: OR 5.45, 95% CI 3.91-7.59, p< 0.001].

Discussion: This study highlights the increased risk of complications and a higher prevalence of co-morbidities in pregnant women with a history of bariatric surgery. Hence, this population should be considered high-risk pregnancies and undergo close counseling.

Impact of bariatric surgery status on pregnancy-related Complications and healthcare burden
	Bariatric surgery status vs non-obese controls	adjusted OR	P-value	Bariatric surgery status vs obese-without-bariatric surgery controls	adjusted OR	P-value
Hypertension	1574 (26.29%) vs 322870 (15.19%)	1.70 (1.48-1.94)	< 0.001	1574 (26.29%) vs 132224 (25.92%)	0.87 (0.76-0.99)	0.049
Gestational Hypertension	574 (9.6%) vs 212955 (10.02%)	0.95 (0.77-1.17)	0.664	574 (9.6%) vs 66154 (12.97%)	0.70 (0.57-0.86)	0.001
Diabetes	270 (4.51%) vs 31004 (1.46%)	1.38 (0.90-2.01)	0.137	270 (4.51%) vs 22789 (4.47%)	0.54 (0.35-0.84)	0.007
GDM	550 (9.18%) vs 173800 (8.18%)	0.90 (0.73-1.1)	0.33	550 (9.18%) vs 82700 (16.21%)	0.43 (0.35-0.52)	< 0.001
Pregnancy-related liver disease	140 (2.34%) vs 25410 (1.2%)	1.67 (1.11-2.5)	0.012	140 (2.34%) vs 8830 (1.73%)	1.35 (0.90-2.03)	0.145
Severe pre-eclampsia	184 (3.09%) vs 93109 (4.38%)	0.63 (0.44-0.89)	0.01	184 (3.09%) vs 30210 (5.92%)	0.48 (0.34-0.69)	< 0.001
Mild-moderate pre-eclampsia	395 (4.92%) vs 81294 (3.83%)	1.15 (0.87-1.52)	0.312	395 (4.92%) vs 36129 (7.08%)	0.59 (0.45-0.79)	< 0.001
Mental health disorders	1590 (26.54%) vs 235279 (11.07%)	2.65 (2.31-3.05)	< 0.001	1590 (26.54%) vs 85845 (16.83%)	1.71 (1.48-1.96)	0.001
Alcohol dependence	60 (1%) vs 5329 (0.25%)	2.45 (1.30-4.61)	0.005	60 (1%) vs 1115 (0.22%)	3.45 (1.79-6.66)	< 0.001
Spontaneous or missed abortions	100 (1.67%) vs 18065 (0.85%)	1.50 (0.91-2.46)	0.105	100 (1.67%) vs 1835 (0.36%)	3.28 (1.95-5.5)	< 0.001
Venous thromboembolism	55 (0.92%) vs 3535 (0.17%)	2.47 (1.09-5.55)	0.029	55 (0.92%) vs 1260 (0.25%)	2.0 (0.88-4.54)	0.095
Hyperemesis	195 (3.26%) vs 27760 (1.31%)	3.04 (2.18-4.24)	< 0.001	195 (3.26%) vs 3145 (0.62%)	6.25 (4.46-8.81)	< 0.001
Nutrition deficiency	225 (3.76%) vs 12770 (0.6%)	5.45 (3.91-7.59)	< 0.001	225 (3.76%) vs 5775 (1.13%)	2.85 (2.03-4.0)	< 0.001
	Bariatric surgery status vs non-obese controls	Difference on regression, bariatric surgery group vs non-obese controls	P-value	Bariatric surgery status vs obese controls	Difference on regression, bariatric surgery group vs obese controls	P-value
Total charges ($)	29415 vs 25547	2.98 (-236 to 4632)	0.654	29415 vs 27839	855 (-1692 to 3402)	0.51
Mean length of stay (days)	2.87 vs 2.7	0.046 (-0.15 to 0.24)	0.077	2.87 vs 2.98	negative 0.19 (-0.39 to 0.008)	0.06
*Adjusted odds ratio, ^ Confidence interval. For all analyses, non-obese controls were the referent group. All odds ratios were obtained while adjusting for age, race, hospital location and teaching status, hospital region, insurance type, and charlson comorbidity index.
Hospitalization characteristics of all pregnant admissions in 2020
	Non-obese pregnant controls	Obese pregnant controls	Bariatric surgery status	p-value
Total Number of Hospitalizations	2124870	510130	5990
Mean Age (years) ± Standard Error	29.51(29.42-29.61)	29.52(29.43-29.61)	33.09 (32.8-33.39)
Age Groups				< 0.001
< 35	1772450 (83.41%)	424545 (83.22%)	3960 (66.11%)
>35	352420 (16.59%)	85584 (16.78%)	2029 (33.89%)
Race				< 0.001
White	1073180 (52.18%)	223385 (44.89%)	2870 (49.14%)
Black	329715 (16.03%)	112630 (22.63%)	1130 (19.35%)
Hispanic	417755 (20.31%)	124440 (25%)	1525 (26.11%)
Asian	128220 (6.23%)	14600 (2.93%)	65 (1.11%)
Other	107810 (5.24%)	22615 (4.54%)	250 (4.28%)
Charlson Comorbidity Index (CCI)				< 0.001
CCI=0	1938385 (91.22%)	426730 (83.65%)	4735 (79.05%)
CCI=1	170709 (8.03%)	75209 (14.74%)	1100 (18.36%)
CCI=2	11914 (0.56%)	6324 (1.24%)	114 (1.92%)
CCI≥3	3860 (0.18%)	1864 (0.37%)	40 (0.67%)
Hospital Region				0.0086
Northeast	368124 (17.32%)	75035 (14.71%)	1670 (27.88%)
Midwest	425870 (20.04%)	107380 (21.05%)	1085 (18.11%)
South	838165 (39.69%)	208160 (40.81%)	1755 (29.3%)
West	492709 (23.19%)	119554 (23.44%)	1480 (24.71%)
Hospital Bed-Size				0.0092
Small	414759 (19.52%)	94349 (18.5%)	1080 (18.03%)
Medium	614999 (28.94%)	136470 (26.75%)	1600 (26.71%)
Large	1095111 (51.54%)	279310 (54.75%)	3310 (55.26%)
Hospital Location and Teaching Status				< 0.001
Rural	166080 (7.82%)	34775 (6.82%)	325 (5.43%)
Urban Non-teaching	343575 (16.17%)	70555 (13.83%)	900 (15.03%)
Urban Teaching	1615214 (76.01%)	404799 (79.35%)	4764 (79.55%)
Discharge type				< 0.001
Routine (Home)	2077020 (97.77%)	498655 (97.78%)	5685 (94.99%)
Transfer to short-term hospital	10765 (0.51%)	2034 (0.4%)	75 (1.25%)
Transfer Another Facility*	2734 (0.13%)	535 (0.1%)	15 (0.25%)
Home Health Care	20769 (0.98%)	6294 (1.23%)	130 (2.17%)
Discharge Against Medical Advice	13160 (0.62%)	2475 (0.49%)	80 (1.34%)
Insurance				< 0.001
Medicare	15299 (0.74%)	5010 (1.01%)	190 (3.27%)
Medicaid	869815 (42.21%)	249590 (50.1%)	2375 (40.91%)
Private insurance	1123325 (54.52%)	235645 (47.3%)	3190 (54.95%)
Self-pay	52045 (2.53%)	7960 (1.6%)	50 (0.86%)

Table: Part 1: Comparison of complication rates and outcomes in pregnant admissions with history of bariatric surgery compared with obese and non-obese controls.
Part 2: Hospitalization characteristics of pregnant admissions.

Disclosures:

Bhanu Siva Mohan Pinnam indicated no relevant financial relationships.

Violeta Popov indicated no relevant financial relationships.

Shahroz Fatima indicated no relevant financial relationships.

Bhanu Siva Mohan Pinnam, MD¹, Violeta Popov, MD, PhD², Shahroz Fatima, MD². P1164 - Impact of Prior Bariatric Surgery on Pregnancy Outcomes: A Retrospective Nationwide Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.