Bariatric Surgery and Its Impact on Gestational Diabetes

Obesity is a worldwide epidemic. It affects both developed and developing countries with rates that more than doubled since 1980. The prevalence of overweight and obesity increased by 28% in adults and 47% in children between 1980 and 2013. It affects people of all ages, including women of reproductive age. In the United States, more than 55% of reproductive age women are overweight or obese, over 30% are obese, and 7% are considered morbidly obese. It is estimated that about a third of women are now obese at the beginning of their pregnancy. Obesity is a known risk factor for diabetes mellitus (DM), and in pregnancy has been associated with an increased risk for the development of gestational diabetes mellitus (GDM). Other obesity-related complications of pregnancy include preeclampsia, fetal macrosomia, stillbirth, post-term pregnancy, and cesarean delivery (CD). Long-term maternal complications include higher risks for cardiovascular disease, ophthalmic disease, and even gynecological malignancies such as ovarian and breast cancer. Maternal obesity is related to neonatal complications, including higher rates of early neonatal death and even long-term sequelae leading to future metabolic syndrome in the offspring. Bariatric surgery (BS) for obese patients with DM results in the largest degree of sustained weight loss along with the largest improvement in blood glucose control. It is indicated for morbidly obese patients or obese patients with obesity-related comorbidities. From an obstetrical point of view, reaching normal pre-pregnancy weight and BMI may reduce the risk of complications in pregnancy and adverse perinatal outcomes. BS is becoming an increasingly utilized approach to achieve weight loss. It has been shown to be the most effective and durable treatment for obesity and to reduce obesity-related complications during pregnancy. This chapter addresses the impact of BS on GDM and the resulting perinatal outcomes.