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Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1662 (Published 13 April 2010) Cite this as: BMJ 2010;340:c1662
  1. Wendy L Bennett, assistant professor1,
  2. Marta M Gilson, assistant professor2,
  3. Roxanne Jamshidi, assistant professor3,
  4. Anne E Burke, assistant professor3,
  5. Jodi B Segal, associate professor1,
  6. Kimberley E Steele, assistant professor2,
  7. Martin A Makary, associate professor2,
  8. Jeanne M Clark, associate professor1
  1. 1Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument Street, Room 2-611, Baltimore, MD 21205, USA
  2. 2Department of Surgery, The Johns Hopkins University School of Medicine
  3. 3Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine
  1. Correspondence to: W L Bennett wbennet5{at}jhmi.edu
  • Accepted 1 February 2010

Abstract

Objective To determine whether women who had a delivery after bariatric surgery have lower rates of hypertensive disorders in pregnancy compared with women who had a delivery before bariatric surgery.

Design Retrospective cohort study.

Setting Claims data for 2002-6 from seven insurance plans in the United States.

Participants 585 women aged 16-45 who had undergone bariatric surgery, had at least one pregnancy and delivery, and had continuous insurance coverage during pregnancy plus two weeks after delivery.

Main outcome measure Hypertensive disorders in pregnancy defined with ICD-9 codes. The independent variable was the timing of delivery in relation to bariatric surgery, classified as deliveries before and after surgery. We used logistic regression to calculate odds ratios and confidence intervals for each type of hypertensive disorder in pregnancy.

Results Among the 585 women who had undergone bariatric surgery and had a delivery, 269 delivered before surgery and 316 delivered after surgery. Gastric bypass was the surgery in 82% (477) of all women. Women who delivered before surgery were younger at the time of delivery (mean age 31.3 v 32.5) but had higher rates of pre-existing diabetes and gestational diabetes mellitus. Compared with women who delivered before surgery, women who delivered after surgery had substantially lower rates of pre-eclampsia and eclampsia (odds ratio 0.20, 95% confidence interval 0.09 to 0.44), chronic hypertension complicating pregnancy (0.39, 0.20 to 0.74), and gestational hypertension (0.16, 0.07 to 0.37), even after adjustment for age at delivery, multiple pregnancy (that is, twins or more), surgical procedure, pre-existing diabetes, and insurance plan.

Conclusion In this retrospective analysis of US women, bariatric surgery was associated with lower rates of hypertensive disorders in subsequent pregnancy.

Footnotes

  • Contributors: WLB contributed to the development of the research question, study planning and analysis, interpretation of the results, and drafting the manuscript. She is guarantor. MMG contributed to the development of the research question, study planning, data analysis, interpretation of the results, and editing the manuscript. RJ, AEB, and JMC contributed to the development of the research question, study planning, interpretation of the results, and editing the manuscript. JBS, KES, and MAM contributed to the development of the research question, study planning, and editing the manuscript.

  • Funding: The dataset used in this study was created for a research project on the patterns of obesity care within selected BlueCross BlueShield plans. The original development of the dataset was funded by unrestricted research grants from Ethicon Endo-Surgery, Pfizer, and GlaxoSmithKline. Data and database development support were provided by the BlueCross BlueShield Association (Tennessee, Hawaii, Michigan, North Carolina), Highmark (Pennsylvania), Independence BlueCross (Pennsylvania), and Wellmark BlueCross BlueShield (Iowa and South Dakota). The BlueCross BlueShield plans were invited to review the manuscript but they did not have any direct role in the design and conduct of the study, data management or analysis, interpretation of the data, or preparation of the manuscript.

  • Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) (URL) and declare (1) no financial support for the submitted work from anyone other than their  employer; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: The study was approved by the institutional review board of the Johns Hopkins University School of Medicine.

  • Data sharing: No additional data available.

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