Intrauterine Fetal Growth Delay During Late Pregnancy After Maternal Gastric Bypass Surgery

Abstract

Purpose To investigate intrauterine fetal growth development and birth anthropometry of fetuses conceived after maternal gastric bypass surgery.

Materials and Methods Longitudinal cohort study describing longitudinal growth estimated by ultrasound on 43 singleton pregnancies after gastric bypass compared to 43 BMI-matched controls.

Results In fetuses after maternal gastric bypass surgery, growth percentiles decreased markedly from the beginning of the second trimester until the end of the third trimester (decrease of 3.1 fetal abdomen circumference percentiles (95 %CI 0.9–5.3, p = 0.007) per four gestational weeks). While in the second trimester, fetal anthropometric measures did not differ between the groups, the mean abdomen circumference percentiles appeared significantly smaller during the third trimester in offspring of mothers after gastric bypass (mean difference 25.1 percentiles, p < 0.001). Similar tendencies have been observed in estimated fetal weight resulting in significantly more SGA offspring at delivery in the gastric bypass group. In children born after maternal gastric bypass surgery, weight percentiles (32.12^th vs. 55.86^th percentile, p < 0.001) as well as placental weight (525.2 g vs. 635.7 g, p < 0.001) were significantly reduced compared to controls.

Conclusion In fetuses conceived after maternal gastric bypass, intrauterine fetal growth distinctively declined in the second and third trimester, most prominently observed in fetal abdomen circumferences. Birth weight and placental weight at birth was significantly lower compared to BMI-matched controls, possibly due to altered maternal metabolic factors and comparable to mothers experiencing chronic hunger episodes.

Zusammenfassung

Ziel Das intrauterine Wachstum von Feten in Schwangerschaften nach maternaler Magenbypass-Operation zu untersuchen.

Material und Methode Longitudinale Kohortenstudie an 43 Einlings-Schwangerschaften nach maternalem Magenbypass und 43 BMI-gematchten Kontrollen. Das longitudinale fetale Wachstum wurde anhand von wiederholten Ultraschallmessungen beobachtet.

Ergebnisse In Feten nach maternalem Magenbypass konnte eine deutliche Abflachung der Wachstums-Perzentilen vom Anfang des zweiten Trimenons bis zum Ende des dritten Trimenons beobachtet werden (Abfall von 3,1 fetalen Abdomen-Umfang-Perzentilen (95 % CI 0,9–5,3, p = 0,007) innerhalb von 4 Schwangerschaftswochen). Während sich im zweiten Trimenon vergleichbare fetale Messwerte in beiden Gruppen zeigten, hatten Feten nach maternalem Magenbypass im dritten Trimenon signifikant kleinere Abdomen-Umfänge verglichen mit Kontrollen (durchschnittliche Differenz 25,1 Perzentilen, p < 0,001). Vergleichbare Resultate konnten bezüglich fetalem Schätzgewicht beobachtet werden mit daraus resultierenden signifikant häufigeren SGA-Neugeborenen nach maternalem Magenbypass. Neugeborene nach Magenbypass hatten signifikant erniedrigte Geburtsgewichts-Perzentilen (32,12. vs. 55,86. Perzentile, p < 0,001) sowie ein signifikant erniedrigtes durchschnittliches Plazentagewicht (525,2 g vs. 635,7 g, p < 0,001).

Schlussfolgerung In Feten nach maternalem Magenbypass konnte eine deutliche Abnahme des intrauterinen Wachstums im zweiten und dritten Trimenon beobachtet werden – am ausgeprägtesten im Hinblick auf fetale Abdomen-Umfänge. Das Geburts- und Plazentagewicht war signifikant erniedrigt verglichen mit BMI-gematchten Kontrollen, möglicherweise aufgrund von maternalen metabolischen Faktoren und vergleichbar mit an chronischem Hunger leidenden Müttern.

Key words

gastric bypass - pregnancy - SGA - fetal growth - bariatric surgery

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