Maternal and neonatal outcomes for pregnancies before and after gastric bypass surgery.

BACKGROUND: Interaction between maternal obesity, intrauterine environment and adverse clinical outcomes of newborns has been described. METHODS: Using statewide birth certificate data, this retrospective, matched-control cohort study compared paired birth weights and complications of infants born to women before and after Roux-en-Y gastric bypass surgery (RYGB) and to matched obese non-operated women in several different groups. Women who had given birth to a child before and after RYGB (group 1; n=295 matches) and women with pregnancies after RYGB (group 2; n=764 matches) were matched to non-operated women based on age, body mass index (BMI) prior to both pregnancy and RYGB, mother's race, year of mother/s birth, date of infant births and birth order. In addition, birth weights of 13 143 live births before and/or after RYGB of their mothers (n=5819) were compared (group 3). RESULTS: Odds ratios (ORs) for having a large-for-gestational-age (LGA) neonate were significantly less after RYGB than for non-surgical mothers: ORs for groups 1 and 2 were 0.19 (0.08-0.38) and 0.33 (0.21-0.51), respectively. In contrast, ORs in all three groups for risk of having a small for gestational age (SGA) neonate were greater for RYGB mothers compared to non-surgical mothers (ORs were 2.16 (1.00-5.04); 2.16 (1.43-3.32); and 2.25 (1.89-2.69), respectively). Neonatal complications were not different for group 1 RYGB and non-surgical women for the first pregnancy following RYGB. Pregnancy-induced hypertension and gestational diabetes were significantly lower for the first pregnancy of mothers following RYGB compared to matched pregnancies of non-surgical mothers. CONCLUSION: Women who had undergone RYGB not only had lower risk for having an LGA neonate compared to BMI-matched mothers, but also had significantly higher risk for delivering an SGA neonate following RYGB. RYGB women were less likely than non-operated women to have pregnancy-related hypertension and diabetes.

Carotid duplex scan versus angiography in evaluation of carotid artery disease.

Angiography is presently felt to be the most accurate means of evaluating the carotid artery bifurcation, and is required preoperatively by most vascular surgeons. Arterial digital subtraction angiography (DSA) is the method commonly used. Angiography, however, is expensive and invasive, with significant morbidity and mortality. Duplex scanning (DS) has gained acceptance as a screening technique and has recently been advocated as the sole preoperative study in several centers because it is non-invasive and has an accuracy that is equal to or better than angiography. This study preoperatively evaluated 41 carotid arteries in 38 patients by arterial digital subtraction angiography and duplex scanning, and the results were compared to the surgical specimen. One artery was excluded because of an inadequate duplex scan, leaving 40 arteries studied by both techniques. Forty arteries (100%) studied by duplex scans corresponded with the surgical specimen, whereas only 31 arteries (77.5%) studied by DSA corresponded with the surgical specimen. Nine arteries (22.5%) studied by DSA had stenosis at the time of surgery significantly greater than predicted by DSA. Three arteries (7%) were felt to be normal by DSA, but had approximately 80 per cent stenosis by DS and at surgery. Our findings indicate that duplex scanning at our institution is more accurate than arterial DSA in determining percent diameter stenosis and plaque morphology of carotid arteries.