Maternal cardiovascular adaptation to pregnancy in women with previous bariatric surgery and obese pregnant women

Abstract

The prevalence of obesity in pregnancy is rising every year both in the UK and globally. Obese pregnant women are often of childbearing age and go on to have high risk pregnancies with increased risk of hypertensive disorders, gestational diabetes and large-for-gestational age neonates. Bariatric Surgery is a highly successful treatment for sustained weight loss and its use in the management of obesity is growing. Studies of individuals before and after bariatric surgery, outside of pregnancy, have shown a reduction or resolution in hypertension, cardiac remodelling with reduced left ventricular mass and improved function. Numerous retrospective studies have shown that pregnancy following bariatric surgery is associated with a reduced risk of developing hypertensive disorders, however, the mechanisms for this are largely unknown. In pathological pregnancy complicated by pre-eclampsia or growth restriction, studies have shown cardiovascular alterations in haemodynamic indices, cardiac geometry and function, highlighting the importance of the cardiovascular adaptation to pregnancy. This study is a prospective, observational study aiming to investigate the maternal cardiovascular adaptation to pregnancy in women with previous bariatric surgery compared to women with similar early pregnancy BMI and similar pre-surgery BMI. In addition, we investigated the cardiovascular adaptation to pregnancy in obese pregnant women compared to normal BMI pregnant women and the placental function in obese pregnant women and its association with cardiovascular parameters. Cardiovascular function was assessed at three time points during pregnancy by measuring blood pressure and using transthoracic echocardiography to assess haemodynamic function, cardiac geometry and systolic and diastolic function.