ABSTRACT Background There is a lack of evidence regarding the impact of body weight on the safety of surgical abortion. Study Design We performed a systematic review and meta‐analysis of observational studies reporting the effects of obesity on perioperative anaesthetic and surgical outcomes during surgical abortion. Analytical observational studies examining individuals undergoing surgical abortion up to 28 weeks gestation were eligible for inclusion if they reported perioperative anaesthetic or surgical outcomes in participants with body mass index (BMI) in two groups: BMI < 30 kg/m 2 and BMI ≥ 30 kg/m 2 . Sub‐analyses were performed comparing outcomes in those with BMI < 30 kg/m 2 and ≥ 40 kg/m 2 . Results Eight retrospective cohort studies were included, comprising 9912 obese and 31 672 non‐obese participants. 1770 participants had BMI ≥ 40 kg/m 2 and only 71 had BMI ≥ 50 kg/m 2 . BMI ≥ 30 kg/m 2 was not associated with an increase in major surgical adverse outcomes (RR 95% CIs 1.16 0.83–1.62) compared to BMI < 30 kg/m 2 . BMI ≥ 40 kg/m 2 was associated with increased risk of major complications (RR 95% CIs 2.60 1.28–5.28) based on low‐quality evidence from two studies on second‐trimester surgical abortion. Anaesthetic adverse outcomes were rare and not increased by BMI ≥ 30 kg/m 2 (RR 95% CIs 1.02 0.50–2.06) or BMI ≥ 40 kg/m 2 (RR 95% CIs 2.0 0.55–7.24). Conclusions Anaesthetic and surgical risks are not increased by BMI ≥ 30 kg/m 2 . Individuals with BMI ≥ 40 kg/m 2 may have increased risk of major surgical complications. The lack of sufficient data on those in the BMI ≥ 40 kg/m 2 and BMI ≥ 50 kg/m 2 categories underscores the need for further research to ensure high‐quality abortion care for this population.
Drever et al. (2026) studied this question.