Pregnancy after adjustable gastric banding.

OBJECTIVE: To determine outcomes of pregnancies of obese women who had surgical placement of an adjustable gastric band to treat obesity.
METHODS: We conducted two clinical trials to evaluate adjustable gastric banding that involved 359 obese women of reproductive potential (age 18-51 years), of whom 20 conceived resulting in 23 pregnancies. Specific information about pregnancies and fetal outcomes was collected from medical records and direct patient contact.
RESULTS: Eighteen pregnancies were full term, one was an ectopic gestation, two ended in elective abortions, and two in spontaneous abortions unrelated to the womens' medical conditions. Of the 18 full-term pregnancies, 14 delivered vaginally and four by cesarean (one for prolonged fetal bradycardia, two for cephalopelvic disproportion, and one repeat cesarean for twins). The mean birth weight was 3676 g (range 2381-3912 g). Five women lost weight (range 1.8-17.6 kg) during pregnancy without obvious fetal and neonatal effects. Three women had fluid removed from their gastric bands (decreasing the mechanical constriction) to treat nausea and vomiting. Two women who had no fluid in their bands eliminated the effectiveness of the obesity treatment, resulting in excessive weight gain.
CONCLUSION: Morbidly obese women who became pregnant soon after receiving an adjustable gastric band had uncomplicated pregnancies. Adjustment of the gastric band to decrease the amount of mechanical obstruction decreased nausea and vomiting, but led to excessive weight gain in two women when it was done prophylactically. Obese women at risk of pregnancy should be counseled that it might occur unexpectedly after weight loss from gastric banding unless birth control is promptly instituted.