Impact of bariatric surgery on hypertensive disorders in pregnancy

Retrospective analysis of insurance claims data

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numberc1662
Pages (from-to)1180
Number of pages1
JournalBMJ (Online)
Volume340
Issue number7757
DOIs
StatePublished - May 29 2010

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Insurance Claim Review
Bariatric Surgery
Insurance
Pregnancy
International Classification of Diseases
Odds Ratio
Confidence Intervals
Pregnancy Induced Hypertension
Multiple Pregnancy
Eclampsia
Insurance Coverage
Gastric Bypass
Gestational Diabetes
Pre-Eclampsia
Cohort Studies
Retrospective Studies
Logistic Models
Outcome Assessment (Health Care)
Hypertension

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{ef15ceed84e94d3ababb493994bf97a5,
title = "Impact of bariatric surgery on hypertensive disorders in pregnancy: Retrospective analysis of insurance claims data",
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.",
author = "Wendy Bennett and Gilson, {Marta M.} and Roxanne Jamshidi and Anne Burke and Jodi Segal and Kimberley Steele and Makary, {Martin A} and Jeanne Clark",
year = "2010",
month = "5",
day = "29",
doi = "10.1136/bmj.c1662",
language = "English (US)",
volume = "340",
pages = "1180",
journal = "British Medical Journal",
issn = "0959-8146",
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TY - JOUR

T1 - Impact of bariatric surgery on hypertensive disorders in pregnancy

T2 - Retrospective analysis of insurance claims data

AU - Bennett, Wendy

AU - Gilson, Marta M.

AU - Jamshidi, Roxanne

AU - Burke, Anne

AU - Segal, Jodi

AU - Steele, Kimberley

AU - Makary, Martin A

AU - Clark, Jeanne

PY - 2010/5/29

Y1 - 2010/5/29

N2 - 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.

AB - 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.

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U2 - 10.1136/bmj.c1662

DO - 10.1136/bmj.c1662

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JO - British Medical Journal

JF - British Medical Journal

SN - 0959-8146

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