Bariatric surgery & Pregnancy Outcomes · Web viewperipartum period/ or exp postpartum period/ or...

Bariatric Surgery and Outcomes of Pregnancy Online Supplement

Search Strategy............................................................................................................................................ 2

Newcastle-Ottawa Scale - Total Scores for all included studies.............................................3

Newcastle-Ottawa Scale – Individual results for all included studies.................................5

Consistency of Direction of Effects – Studies in Primary Analysis........................................6

Forest Plots – Studies in Primary Analysis......................................................................................7

Consistency of Direction of Effects – all studies.........................................................................22

Assessment of publication bias using funnel plots – all studies..........................................24

Forest plots – all studies........................................................................................................................26

Characteristics of all included studies…………………………………………………………………36

1


Search Strategy Medline Search Strategy & Summary of Results Bariatric Surgery and Pregnancyon December 12, 2016

bariatric surgery/ or gastric bypass/ or gastroplasty/ or jejunoileal bypass/ or lipectomy/ or (bariatric surger* or gastric bypass* or gastroplasty* or jejunoileal bypass* or lipectomy* or stomach bypass*).mp. or Gastroplasty/ or gastric band*.mp. or sleeve gastrectom*.mp. or BiliopancreaIc Diversion/ or bilipancreaIc adj (bypass* or diversion*) or Obesity/su [Surgery] or Obesity, Morbid/su [Surgery] or Obesity, Abdominal/su [Surgery] or Obesity, Metabolically Benign/su [Surgery]

AND

exp pregnancy/ or exp fetus/ or exp pregnancy complicaIons/ or exp infant, newborn/peripartum period/ or exp postpartum period/ or (pregnan* or obstetric* or gestaIon*).mp. or (f?etus or f?etal).mp. or newborn.mp. or (new adj1 born).mp. or neonat*.mp. or infan*.mp. or birth*.mp. or childbirth*.mp. or (labo?r or labo?rs or labo?uring or puerper* or C?esar* or episiotomy*).mp.exp fetal development/ or exp prenatal diagnosis/ or exp fetal monitoring/ or exp perinatal care/ or prenatal care/ or postnatal care/ or exp maternal health services/ or exp anesthesia, obstetrical/ or exp analgesia, obstetrical/ or exp parity/ or exp apgar score/ or exp pregnancy trimesters/ or ((forcep* or vacuum or ventouse or instrument* or vaginal) adj2 deliver*).mp. or (antepart* or ante-part* or prenat* or pre-nat* or perinat* or peri-nat* or peripart* or peri-part*).mp. or postnat*.mp. or post-nat*.mp. or postpart*.mp. or post-part*.mp. or breasTe*.mp. or obstetrics/ or maternal welfare/ or maternal mortality/ or pregnant woman/ or Pregnancy Outcome/ or exp heart rate, fetal/ or exp fetal therapies/ or exp placenta/ or exp placental funcIon tests/ or exp umbilical cord/

NOTAnimals/ not humans/

Summary of Results

All searches were conducted on December 12, 2016.

Medline 1946 to December 13, 2016 847

Embase 1947 to Week 50 1136

Cochrane To November 2016 36

Web of Science 1900 to December 13, 2016 511

PubMed (non Medline and inprocess) To December 13, 2016 86

2


TOTAL 2616

3


Newcastle-Ottawa Scale - Total Scores for all included studies

StudySelection

(max 4 points)Comparability (max 2 points)

Outcome

(max 3 points) Total Score

Richards (1987)40 4 2 2 8

Marceau (2004)25 4 0 2 6

Dixon (2005)38 4 2 3 8

Patel (2008)33 4 0 2 6

Wax (2008)33 4 2 2 8

Weintraub (2008)31 4 0 3 7

Bennett (2010)34 4 1 3 8

Burke (2010)37 4 1 3 8

Lapolla (2010)36 4 1 2 7

Santulli (2010)30 4 1 2 7

Belogolovkin (2011)21 3 2 3 8

Josefsson (2011)21 4 0 3 7

Lesko (2012)28 4 2 3 9

Kjær (2013)27 4 2 3 9

4


StudySelection

(max 4 points)Comparability (max 2 points)

Outcome

(max 3 points) Total Score

Roos (2013)26 4 2 3 9

Berlac (2014)35 4 2 3 9

Shai (2014)19 4 1 3 8

Johansson (2015)20 4 2 3 9

Parker (2016)24 4 2 3 9

Feichtinger (2017)39 4 2 3 8

5


Newcastle-Ottawa Scale – Individual results for all included studies

6


Consistency of Direction of Effects – Studies in Primary AnalysisOutcome Pooled OR Statistical

Heterogeneity Direction of Effect Same as Pooled ORI2 Interpretation

GDM 0.21 49.4% Moderate 5 of 5 (100%)LGA 0.31 77.3% Substantial 3 of 3 (100%)Macrosomia 0.32 83.2% Substantial 5 of 5 (100%)Postpartum hemorrhage

0.32 46.8% Moderate 2 of 2 (100%)

Large babies 0.35 80.5% Substantial 6 of 6 (100%)All HTD 0.38 0% None 4 of 4 (100%)Gestational HTN 0.39 0% None 3 of 3 (100%)Pre-eclampsia 0.59 0% None 3 of 3 (100%)C-section 0.63 61.8% Substantial 3 of 4 (75%)NICU admission 1.26 76.7% Substantial 1 of 2 (50%)Malformations 1.29 63.0% Substantial 2 of 4 (50%)Neonatal deaths 1.31 58.7% Substantial 2 of 3 (66.7%)Pre-term delivery 1.33 0% None 4 of 4 (100%)Stillbirth 1.4 43.6% Moderate 2 of 4 (50%)IUGR 1.6 0% None 1 of 2 (50%)SGA 2.18 50.4% Substantial 5 of 6 (83.3%)Small babies 2.18 50.4% Substantial 5 of 6 (83.3%)For each outcome, the table shows the pooled OR, the I2, the standard interpretation of the I2, number and percentage of studies that have ORs in the same direction as the overall OR, along with a simple vote-counting summary of whether there is consistency in the direction of the individual ORs.

7


Forest Plots – Studies in Primary Analysis

Source

Total (fixed effect)Total (random effects)Heterogeneity: χ4

2 = 7.90 (P = .10), I2 = 49%

Patel (2008)Burke (2010)Lapolla (2010)Lesko (2012)Johansson (2015)

OR (95% CI)

0.21 [0.15; 0.30]0.21 [0.12; 0.36]

0.27 [0.03; 2.76]0.23 [0.14; 0.37]0.06 [0.02; 0.17]0.46 [0.14; 1.49]0.25 [0.13; 0.48]

0.1 0.5 1 2 10Odds Ratio (95% CI)

GDM

8


Source


2 = 0.32 (P = .96), I2 = 0%

Patel (2008)Weintraub (2008)Lapolla (2010)Lesko (2012)

OR (95% CI)

0.38 [0.27; 0.53]0.38 [0.27; 0.53]

0.56 [0.08; 3.65]0.38 [0.25; 0.58]0.35 [0.19; 0.65]0.46 [0.14; 1.49]

0.1 0.5 1 2 10Odds Ratio (95% CI)

AllHTD

9


Source


2 = 8.83 (P = .01), I2 = 77%

Marceau (2004)Lapolla (2010)Johansson (2015)

OR (95% CI)

0.32 [0.24; 0.41]0.31 [0.17; 0.59]

0.16 [0.08; 0.29]0.61 [0.31; 1.20]0.33 [0.24; 0.45]

0.1 0.5 1 2 10Odds Ratio (95% CI)

LGA

10


Source


2 = 23.87 (P < .01), I2 = 83%

Patel (2008)Burke (2010)Lapolla (2010)Lesko (2012)Johansson (2015)

OR (95% CI)

0.52 [0.38; 0.70]0.32 [0.11; 0.89]

0.08 [0.00; 1.61]0.76 [0.52; 1.11]0.91 [0.34; 2.46]0.19 [0.05; 0.71]0.11 [0.05; 0.24]

0.01 0.1 1 10 100Odds Ratio (95% CI)

Macrosomia

11


Source


2 = 25.59 (P < .01), I2 = 80%

Marceau (2004)Patel (2008)Burke (2010)Lapolla (2010)Lesko (2012)Johansson (2015)

OR (95% CI)

0.40 [0.33; 0.49]0.35 [0.19; 0.62]

0.16 [0.08; 0.29]0.08 [0.00; 1.61]0.76 [0.52; 1.11]0.61 [0.31; 1.20]0.19 [0.05; 0.71]0.33 [0.24; 0.45]

0.01 0.1 1 10 100Odds Ratio (95% CI)

Large babies

12


Source


2 = 10.08 (P = .07), I2 = 50%

Marceau (2004)Patel (2008)Weintraub (2008)Lapolla (2010)Lesko (2012)Johansson (2015)

OR (95% CI)

2.13 [1.69; 2.68]2.18 [1.41; 3.38]

3.26 [1.63; 6.52]2.87 [0.28; 29.59]1.40 [0.84; 2.32]0.28 [0.03; 2.45]5.00 [1.73; 14.41]2.20 [1.64; 2.95]

0.1 0.5 1 2 10Odds Ratio (95% CI)

SGA

13


Source


2 = 0.19 (P = .66), I2 = 0%

Patel (2008)Weintraub (2008)

OR (95% CI)

1.60 [0.69; 3.73]1.60 [0.69; 3.73]

0.88 [0.05; 14.90]1.70 [0.70; 4.11]

0.1 0.5 1 2 10Odds Ratio (95% CI)

IUGR

14


Source


2 = 10.08 (P = .07), I2 = 50%

Marceau (2004)Patel (2008)Weintraub (2008)Lapolla (2010)Lesko (2012)Johansson (2015)

OR (95% CI)

2.13 [1.69; 2.68]2.18 [1.41; 3.38]

3.26 [1.63; 6.52]2.87 [0.28; 29.59]1.40 [0.84; 2.32]0.28 [0.03; 2.45]5.00 [1.73; 14.41]2.20 [1.64; 2.95]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Small babies

15


Source


2 = 0.61 (P = .89), I2 = 0%

Patel (2008)Lapolla (2010)Lesko (2012)Johansson (2015)

OR (95% CI)

1.33 [1.01; 1.75]1.33 [1.01; 1.75]

1.04 [0.30; 3.64]1.43 [0.67; 3.07]1.69 [0.79; 3.63]1.28 [0.92; 1.78]

0.5 1 2Odds Ratio (95% CI)

Pre-term delivery

16


Source


2 = 1.88 (P = .17), I2 = 47%

Burke (2010)Lesko (2012)

OR (95% CI)

0.39 [0.15; 0.99]0.32 [0.08; 1.37]

0.56 [0.19; 1.65]0.12 [0.02; 0.82]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Postpartum hemorrhage

17


Source


2 = 7.86 (P = .05), I2 = 62%

Patel (2008)Burke (2010)Lapolla (2010)Lesko (2012)

OR (95% CI)

0.56 [0.42; 0.74]0.63 [0.39; 1.02]

2.08 [0.74; 5.84]0.48 [0.32; 0.72]0.44 [0.26; 0.75]0.67 [0.36; 1.24]

0.2 0.5 1 2 5Odds Ratio (95% CI)

C-section

18


Source


2 = 4.28 (P = .04), I2 = 77%

Lapolla (2010)Lesko (2012)

OR (95% CI)

1.32 [0.73; 2.37]1.26 [0.37; 4.26]

2.32 [1.05; 5.12]0.67 [0.28; 1.60]

0.2 0.5 1 2 5Odds Ratio (95% CI)

NICU admission

19


Source


2 = 5.32 (P = .15), I2 = 44%

Marceau (2004)Patel (2008)Lesko (2012)Johansson (2015)

OR (95% CI)

1.57 [0.65; 3.80]1.40 [0.38; 5.23]

0.58 [0.07; 4.43]0.16 [0.01; 3.56]8.42 [0.92; 76.80]1.89 [0.59; 6.05]

0.01 0.1 1 10 100Odds Ratio (95% CI)

Stillbirth

20


Source


2 = 4.84 (P = .09), I2 = 59%

Weintraub (2008)Burke (2010)Johansson (2015)

OR (95% CI)

1.21 [0.54; 2.73]1.31 [0.37; 4.71]

0.40 [0.11; 1.44]2.31 [0.59; 8.99]2.93 [0.57; 15.10]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Neonatal deaths

21


Source


2 = 8.12 (P = .04), I2 = 63%

Marceau (2004)Patel (2008)Weintraub (2008)Johansson (2015)

OR (95% CI)

1.24 [0.83; 1.84]1.29 [0.61; 2.71]

1.62 [0.71; 3.73]0.28 [0.01; 7.30]2.50 [1.21; 5.15]0.72 [0.40; 1.29]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Malformations

22


Consistency of Direction of Effects – all studies

Outcome Pooled OR

StatisticalHeterogeneity

Direction of Effects

I2 (%) Interpretation Same as Pooled OR

GDM 0.56 90.0 Substantial 9/16 (56%)Gestational HTN 0.59 77.3 Substantial 5/7 (71%)Pre-eclampsia 0.55 75.0 Substantial 8/9 (89%)Hypertensive disorders 0.29 58.8 Substantial 3/4(75%)AllHTD 0.50 85.8 Substantial 11/14 (79%)LGA 0.39 66.0 Substantial 9/10 (90%)Macrosomia 0.37 72.3 Substantial 8/8 (100%)Large babies 0.40 62.6 Substantial 14/15 (93%)SGA 2.09 26.1 Moderate 11/13 (85%)IUGR 2.64 0.0 None 4/4 (100%)Small babies 2.14 43.4 Moderate 12/15 (80%)Pre-term delivery 1.55 0.0 None 10/11 (91%)Postpartum hemorrhage

0.57 58.2Substantial

6/6 (100%)

C-section 0.98 81.9 Substantial 4/12 (33%)Labor induction 1.03 0.0 None 1/4 (25%)NICU admission 1.3 0.0 None 6/7 (86%)Malformations 1.1 62.3 Substantial 2/5 (40%)Stillbirth 1.5 0.0 None 5/7 (83%)Neonatal deaths 1.1 24.3 Moderate 3/6 (50%)Multiple gestations 1.1 32.8 Moderate 3/4 (75%)

23


For each outcome, the table shows the pooled OR, the I2, the standard interpretation of the I2, number and percentage of studies that have ORs in the same direction as the overall OR, along with a simple vote-counting summary of whether there is consistency in the direction of the individual ORs.

24


Assessment of publication bias using funnel plots – all studies

25


26


Forest plots – all studies

27


Source


2 = 150.34 (P < .01), I2 = 90%

Richards (1987)Dixon (2005)Patel (2008)Wax (2008)Bennett (2010)Burke (2010)Josefsson (2010)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Berlac (2014)Shai (2014)Johansson (2015)Parker (2015)Feichtinger (2017)

OR (95% CI)

0.92 [0.81; 1.04]0.56 [0.34; 0.91]

0.47 [0.11; 1.99]0.29 [0.10; 0.84]0.82 [0.07; 9.52]1.35 [0.22; 8.45]0.43 [0.28; 0.66]0.23 [0.15; 0.37]1.59 [0.22; 11.41]0.06 [0.02; 0.17]1.00 [0.20; 4.88]0.04 [0.00; 0.59]1.27 [0.82; 1.95]1.14 [0.75; 1.73]0.65 [0.44; 0.96]0.27 [0.14; 0.49]1.72 [1.42; 2.08]1.18 [0.62; 2.24]

0.01 0.1 1 10 100Odds Ratio (95% CI)

GDM

Source


2 = 26.45 (P < .01), I2 = 77%

Dixon (2005)Patel (2008)Wax (2008)Bennett (2010)Lapolla (2010)Lesko (2012)Berlac (2014)

OR (95% CI)

0.54 [0.39; 0.76]0.59 [0.27; 1.28]

0.37 [0.11; 1.23]1.68 [0.10; 28.06]4.75 [1.60; 14.13]0.17 [0.08; 0.38]0.35 [0.15; 0.81]0.46 [0.17; 1.29]0.71 [0.42; 1.22]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Gestational HTN

28


Source


2 = 31.95 (P < .01), I2 = 75%

Dixon (2005)Patel (2008)Bennett (2010)Lapolla (2010)Lesko (2012)Kjaer (2013)Berlac (2014)Shai (2014)Parker (2015)

OR (95% CI)

0.81 [0.70; 0.93]0.55 [0.36; 0.83]

0.16 [0.05; 0.49]0.53 [0.05; 5.41]0.15 [0.07; 0.33]0.52 [0.24; 1.15]0.78 [0.29; 2.11]0.56 [0.28; 1.10]0.68 [0.38; 1.22]1.01 [0.63; 1.60]0.93 [0.79; 1.09]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Pre-eclampsia

Source


2 = 7.29 (P = .06), I2 = 59%

Richards (1987)Weintraub (2008)Santulli (2010)Feichtinger (2017)

OR (95% CI)

0.36 [0.25; 0.51]0.29 [0.11; 0.75]

0.11 [0.04; 0.33]0.41 [0.28; 0.60]1.70 [0.17; 17.03]0.16 [0.02; 1.32]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Hypertensive disorders

29


Source


2 = 91.83 (P < .01), I2 = 86%

Richards (1987)Dixon (2005)Patel (2008)Wax (2008)Weintraub (2008)Bennett (2010)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Berlac (2014)Shai (2014)Parker (2015)Feichtinger (2017)

OR (95% CI)

0.69 [0.61; 0.78]0.50 [0.33; 0.77]

0.11 [0.04; 0.33]0.18 [0.08; 0.44]0.81 [0.14; 4.78]4.75 [1.60; 14.13]0.41 [0.28; 0.60]0.14 [0.08; 0.25]0.35 [0.19; 0.66]1.70 [0.17; 17.03]0.56 [0.26; 1.18]0.56 [0.28; 1.10]0.68 [0.46; 1.03]1.01 [0.63; 1.60]0.93 [0.79; 1.09]0.16 [0.02; 1.32]

0.1 0.5 1 2 10Odds Ratio (95% CI)

AllHTD

Source


2 = 26.49 (P < .01), I2 = 66%

Richards (1987)Marceau (2004)Wax (2008)Josefsson (2010)Lapolla (2010)Santulli (2010)Kjaer (2013)Johansson (2015)Parker (2015)Feichtinger (2017)

OR (95% CI)

0.43 [0.37; 0.51]0.39 [0.27; 0.56]

0.32 [0.13; 0.78]0.16 [0.08; 0.29]0.39 [0.02; 8.26]1.02 [0.38; 2.78]0.61 [0.30; 1.21]0.16 [0.01; 2.83]0.31 [0.15; 0.64]0.33 [0.24; 0.44]0.60 [0.47; 0.76]0.32 [0.06; 1.61]

0.01 0.1 1 10 100Odds Ratio (95% CI)

LGA

30


Source


2 = 25.23 (P < .01), I2 = 72%

Dixon (2005)Patel (2008)Wax (2008)Burke (2010)Lapolla (2010)Lesko (2012)Shai (2014)Johansson (2015)

OR (95% CI)

0.45 [0.35; 0.58]0.37 [0.20; 0.68]

0.60 [0.24; 1.47]0.22 [0.01; 4.40]0.39 [0.02; 8.26]0.73 [0.50; 1.06]0.91 [0.34; 2.46]0.21 [0.06; 0.71]0.29 [0.17; 0.50]0.11 [0.05; 0.24]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Macrosomia

Source


2 = 37.39 (P < .01), I2 = 63%

Richards (1987)Marceau (2004)Dixon (2005)Patel (2008)Wax (2008)Burke (2010)Josefsson (2010)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Shai (2014)Johansson (2015)Parker (2015)Feichtinger (2017)

OR (95% CI)

0.45 [0.39; 0.52]0.40 [0.30; 0.54]

0.32 [0.13; 0.78]0.16 [0.08; 0.29]0.60 [0.24; 1.47]0.22 [0.01; 4.40]0.39 [0.02; 8.26]0.73 [0.50; 1.06]1.02 [0.38; 2.78]0.61 [0.30; 1.21]0.16 [0.01; 2.83]0.21 [0.06; 0.71]0.31 [0.15; 0.64]0.29 [0.17; 0.50]0.33 [0.24; 0.44]0.60 [0.47; 0.76]0.32 [0.06; 1.61]

0.01 0.1 1 10 100Odds Ratio (95% CI)

Large babies

31


Source


2 = 16.23 (P = .18), I2 = 26%

Richards (1987)Marceau (2004)Patel (2008)Wax (2008)Weintraub (2008)Josefsson (2010)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Roos (2013)Johansson (2015)Feichtinger (2017)

OR (95% CI)

2.00 [1.74; 2.29]2.09 [1.71; 2.56]

2.08 [0.36; 11.81]3.26 [1.63; 6.53]5.48 [0.54; 55.72]0.84 [0.21; 3.47]1.36 [0.84; 2.20]2.74 [1.28; 5.88]0.28 [0.03; 2.45]1.73 [0.33; 9.12]3.93 [1.47; 10.49]2.55 [1.51; 4.33]1.77 [1.44; 2.17]2.24 [1.71; 2.93]3.25 [1.33; 7.89]

0.1 0.5 1 2 10Odds Ratio (95% CI)

SGA

Source


2 = 2.23 (P = .53), I2 = 0%

Patel (2008)Weintraub (2008)Santulli (2010)Parker (2015)

OR (95% CI)

2.64 [2.14; 3.25]2.64 [2.14; 3.25]

5.12 [0.20; 130.38]1.72 [0.72; 4.13]15.38 [0.61; 389.26]2.68 [2.16; 3.32]

0.01 0.1 1 10 100Odds Ratio (95% CI)

IUGR

32


Source


2 = 24.73 (P = .04), I2 = 43%

Richards (1987)Marceau (2004)Dixon (2005)Patel (2008)Wax (2008)Weintraub (2008)Josefsson (2010)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Roos (2013)Johansson (2015)Parker (2015)Feichtinger (2017)

OR (95% CI)

2.15 [1.92; 2.41]2.14 [1.75; 2.63]

2.08 [0.36; 11.81]3.26 [1.63; 6.53]0.69 [0.21; 2.29]5.48 [0.54; 55.72]0.84 [0.21; 3.47]1.36 [0.84; 2.20]2.74 [1.28; 5.88]0.28 [0.03; 2.45]1.73 [0.33; 9.12]3.93 [1.47; 10.49]2.55 [1.51; 4.33]1.77 [1.44; 2.17]2.24 [1.71; 2.93]2.68 [2.16; 3.32]3.25 [1.33; 7.89]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Small babies

Source


2 = 6.63 (P = .76), I2 = 0%

Richards (1987)Dixon (2005)Patel (2008)Wax (2008)Josefsson (2010)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Roos (2013)Johansson (2015)

OR (95% CI)

1.54 [1.37; 1.74]1.54 [1.37; 1.74]

1.86 [0.51; 6.72]0.47 [0.15; 1.43]1.61 [0.51; 5.13]1.54 [0.33; 7.27]1.45 [0.78; 2.69]1.43 [0.67; 3.09]1.70 [0.17; 17.03]1.69 [0.79; 3.65]1.30 [0.84; 2.01]1.66 [1.42; 1.93]1.37 [1.00; 1.87]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Pre-term delivery

33


Source


2 = 11.97 (P = .04), I2 = 58%

Burke (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Berlac (2014)Parker (2015)

OR (95% CI)

0.59 [0.46; 0.76]0.57 [0.36; 0.89]

0.68 [0.26; 1.80]0.39 [0.05; 3.16]0.12 [0.02; 0.93]0.93 [0.59; 1.46]0.70 [0.45; 1.09]0.36 [0.23; 0.55]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Postpartum hemorrhage

Source


2 = 60.93 (P < .01), I2 = 82%

Richards (1987)Patel (2008)Wax (2008)Burke (2010)Josefsson (2010)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Berlac (2014)Parker (2015)Feichtinger (2017)

OR (95% CI)

1.17 [1.08; 1.27]0.98 [0.74; 1.29]

1.74 [0.68; 4.41]1.84 [0.68; 4.96]1.11 [0.38; 3.27]0.51 [0.37; 0.70]1.33 [0.84; 2.09]0.44 [0.25; 0.78]2.66 [1.00; 7.08]0.67 [0.37; 1.23]1.21 [0.94; 1.57]1.19 [0.86; 1.65]1.33 [1.20; 1.47]0.42 [0.21; 0.80]

0.2 0.5 1 2 5Odds Ratio (95% CI)

C-section

34


Source


2 = 0.73 (P = .87), I2 = 0%

Wax (2008)Santulli (2010)Kjaer (2013)Feichtinger (2017)

OR (95% CI)

1.03 [0.81; 1.32]1.03 [0.81; 1.32]

1.00 [0.37; 2.73]0.69 [0.24; 2.01]1.07 [0.82; 1.41]0.86 [0.30; 2.51]

0.5 1 2Odds Ratio (95% CI)

Labor induction

Source


2 = 4.83 (P = .57), I2 = 0%

Wax (2008)Lapolla (2010)Santulli (2010)Lesko (2012)Kjaer (2013)Berlac (2014)Feichtinger (2017)

OR (95% CI)

1.26 [1.02; 1.55]1.26 [1.02; 1.55]

1.18 [0.45; 3.12]2.32 [1.04; 5.16]2.57 [0.22; 29.48]0.66 [0.28; 1.55]1.22 [0.85; 1.75]1.26 [0.93; 1.70]1.37 [0.45; 4.16]

0.1 0.5 1 2 10Odds Ratio (95% CI)

NICU admission

35


Source


2 = 10.60 (P = .03), I2 = 62%

Marceau (2004)Patel (2008)Wax (2008)Weintraub (2008)Johansson (2015)

OR (95% CI)

1.16 [0.79; 1.71]1.13 [0.52; 2.43]

1.62 [0.71; 3.73]0.31 [0.01; 6.78]0.21 [0.01; 3.99]2.49 [1.23; 5.06]0.67 [0.38; 1.19]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Malformations

36


Source


2 = 3.77 (P = .58), I2 = 0%

Marceau (2004)Patel (2008)Lesko (2012)Roos (2013)Berlac (2014)Johansson (2015)Parker (2015)

OR (95% CI)

1.47 [1.06; 2.03]1.47 [1.06; 2.03]

0.58 [0.07; 4.44] 8.42 [0.92; 76.85]1.31 [0.80; 2.16]1.33 [0.22; 7.99]1.99 [0.74; 5.31]1.48 [0.87; 2.51]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Stillbirth

Source


2 = 6.60 (P = .25), I2 = 24%

Richards (1987)Weintraub (2008)Burke (2010)Kjaer (2013)Roos (2013)Johansson (2015)

OR (95% CI)

1.13 [0.68; 1.89]1.15 [0.62; 2.13]

1.00 [0.14; 7.35]0.42 [0.13; 1.33]2.31 [0.59; 8.99]0.63 [0.08; 5.22]1.08 [0.48; 2.45]3.19 [0.85; 11.93]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Neonatal deaths

37


Source


2 = 4.46 (P = .22), I2 = 33%

Marceau (2004)Patel (2008)Bennett (2010)Feichtinger (2017)

OR (95% CI)

1.10 [0.67; 1.78]1.11 [0.59; 2.10]

1.82 [0.68; 4.88]3.50 [0.30; 40.65]1.17 [0.57; 2.37]0.49 [0.18; 1.31]

0.1 0.5 1 2 10Odds Ratio (95% CI)

Multiple gestations

38


Characteristics of all included studies

Study Patients

with

Surgery (n)

Patients

without

Surgery (n)

Outcomes Assessed Surgery Type BMI

Matching

Data Type

Richards (1987)40 57 57 GDM, neonatal death, pre-term

delivery, gestational HTN, LGA,

SGA, c-section

Malabsorptive

(100%

malabsorptive)

Pre-surgery

BMI

Clinical

Marceau (2004)25 251 1577 Stillbirth, LGA, SGA, multiple

gestations, miscarriages,

malformations

Malabsorptive

(100%

malabsorptive)

No matching Clinical

Dixon (2005)38 79 79 GDM, macrosomia, pre-term

delivery, pre-eclampsia,

gestational HTN, SGA

Restrictive

(100%

restrictive)

Pre-

pregnancy

BMI

Clinical

Patel (2008)33 26 254 GDM, macrosomia, stillbirth,

pre-term delivery, pre-

eclampsia, gestational HTN,

IUGR, SGA, multiple gestations,

Malabsorptive

(100%

malabsorptive)


39


c-section, malformations

Wax (2008)32 38 76 GDM, macrosomia, NICU

admission, pre-term delivery,

gestational HTN, LGA, SGA,

labor induction, c-section,

malformations

Malabsorptive

(100%

malabsorptive)


Weintraub

(2008)31

507 301 GDM, macrosomia, neonatal

death, pre-eclampsia,

gestational HTN, IUGR, SGA, c-

section, malformations

Mostly

restrictive (did

not specify, just

said ‘mainly)


Bennett (2010)34 316 269 GDM, pre-eclampsia,

gestational HTN, multiple

gestations

Mostly

malabsorptive

(82%

malabsorptive)

No matching Administrative

Burke (2010)37 354 346 GDM, macrosomia, neonatal

death, postpartum hemorrhage,

Cannot tell No matching Administrative

40


c-section

Lapolla (2010)36 83 978 GDM, macrosomia, NICU


pre-eclampsia, gestational HTN,

LGA, SGA, c-section

Restrictive

(100%

restrictive)

Pre-

pregnancy

BMI

Clinical

Santulli (2010)30 24 240 GDM, pre-term delivery, NICU

admission, pre-eclampsia,

IUGR, LGA, SGA, postpartum

hemorrhage, labor induction, c-

section

Malabsorptive

(100%

malabsorptive)

Pre-

pregnancy

BMI

Clinical

Belogolovkin

(2011)

293 656353 GDM, macrosomia, pre-term

delivery, pre-eclampsia, SGA, c-

section

Cannot tell No matching

(adjusted for

pre-

pregnancy

BMI)

Administrative

Josefsson (2011)21 367 188500 GDM, pre-term delivery, LGA,

SGA, c-section

Cannot tell No matching

(adjusted by

BMI

Administrative

41


category)

Lesko (2012)28 70 280 GDM, macrosomia, stillbirth,

NICU admission, pre-term

delivery, pre-eclampsia,

gestational HTN, SGA,

postpartum hemorrhage, c-

section

Mostly

malabsorptive

(86%

malabsorptive)

BOTH pre-

pregnancy

and pre-

surgery BMI

Clinical

Roos (2013)26 2562 1740140 Stillbirth, neonatal deaths, pre-

term delivery, LGA, SGA

Mostly

restrictive (65%

restrictive)

Pre-

pregnancy

BMI

Administrative

Kjær (2013)27 339 1277 GDM, neonatal deaths, NICU


pre-eclampsia, LGA, SGA,

postpartum hemorrhage, labor

induction, c-section

Mostly

malabsorptive

(84%

malabsorptive)

Pre-

pregnancy

BMI

Administrative

Berlac (2014)35 415 826 GDM, stillbirth, NICU admission,

pre-eclampsia, gestational HTN,

postpartum hemorrhage, c-

Malabsorptive

(100%

Pre-

pregnancy

Administrative

42


section malabsorptive) BMI

Shai (2014)19 326 1612 GDM, macrosomia, pre-

eclampsia, c-section

Mostly

restrictive (did

not specify)


Johansson

(2015)20

596 2356 GDM, macrosomia, stillbirth,

neonatal deaths, pre-term

delivery, LGA, SGA,

malformations

Malabsorptive

(98%

malabsorptive)

Pre-surgery

BMI

Administrative

Parker (2016)24 1585 185120 GDM, stillbirth, pre-eclampsia,

IUGR, LGA, postpartum

hemorrhage, c-section

Cannot tell No matching Administrative

Feichtinger

(2017)39

76 76 GDM, NICU admission,

gestational HTN, LGA< SGA,

multiple gestations, labor

induction, c-section

Malabsorptive

(100%

malabsorptive)

Pre-

pregnancy

BMI

Clinical

43


Abbreviations: BMI - body mass index; C-section - cesarean section; GDM - gestational diabetes; HTN - hypertension; IUGR -

intrauterine growth restriction; LGA - large for gestational age; NICU - neonatal intensive care unit; SGA - small for gestational

age

44

Date post:	13-Dec-2018
Category:	Documents
Upload:	lamtuyen
View:	213 times
Download:	0 times

Bariatric surgery & Pregnancy Outcomes · Web viewperipartum period/ or exp postpartum period/ or...

Documents