Current Diabetes Reports

, Volume 7, Issue 4, pp 281–288

Reproductive implications of bariatric surgery: Pre- and postoperative considerations for extremely obese women of childbearing age



Extreme obesity remains a frustrating and formidable disease, with most sufferers requiring surgical intervention in order to achieve long-term, sustained weight loss. Most bariatric procedures today are performed on women, many of whom are of reproductive age; yet minimal evidence exists to guide clinicians in the care of such women before, during, and after pregnancy. This review outlines the fundamental nutritional and surgical alterations of the most commonly performed bariatric procedures with the aim to elucidate a physiologically sound approach to counseling and management of extremely obese women of childbearing age who are either contemplating or have already undergone bariatric surgery. Preconception, pregnancy, and lactation guidelines are offered based on available evidence. Outstanding questions are highlighted for further investigation.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Sturm R: Increases in morbid obesity: 2000–2005. Public Health 2007, Mar 29; [Epub ahead of print].Google Scholar
  2. 2.
    Bergholt T, Lim KL, Jørgensen JS, Robson MS: Maternal body mass index in the first trimester and risk of cesarean delivery in nulliparous women in spontaneous labor. Am J Obstet Gynecol 2007, 196:163.e1–163.e5.CrossRefGoogle Scholar
  3. 3.
    Weiss JL, Malone FD, Emig D, et al.: Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 2004, 190:1091–1097.PubMedCrossRefGoogle Scholar
  4. 4.
    Rosenberg TJ, Garbers S, Chavkin W, Chiasson MA: Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population. Obstet Gynecol 2007, 102:1022–1027.CrossRefGoogle Scholar
  5. 5.
    Villamor E, Cnattingius S: Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006, 368:1164–1170.PubMedCrossRefGoogle Scholar
  6. 6.
    Kristensen J, Vertergaard M, Wisborg K, et al.: Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 2005, 112:403–408.PubMedCrossRefGoogle Scholar
  7. 7.
    Boney CM, Verma A, Tucker R, Vohr BR: Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005, 115:e290–e296.PubMedCrossRefGoogle Scholar
  8. 8.
    Schaefer-Graf UM, Pawliczak J, Passow D, et al.: Birth weight and parental BMI predict overweight in children from mothers with gestational diabetes. Diabetes Care 2005, 28:1745–1750.PubMedCrossRefGoogle Scholar
  9. 9.
    Anderson JW, Konz EC, Wood CL: Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001, 74:579–584.PubMedGoogle Scholar
  10. 10.
    Grodstein F, Levine R, Troy L, et al.: Three-year follow-up of participants in a commercial weight loss program. Can you keep it off? Arch Intern Med 1996, 156:1302–1306.PubMedCrossRefGoogle Scholar
  11. 11.
    Brownell KD, Rodin J: Medical, metabolic, and psychological effects of weight cycling. Arch Intern Med 1994, 154:1325–1330.PubMedCrossRefGoogle Scholar
  12. 12.
    NIH conference. Gastrointestinal surgery for severe obesity. Development Conference Panel [no authors listed]. Ann Intern Med 1991, 115:956–961.Google Scholar
  13. 13.
    Shinogle JA, Owings MF, Kozak LJ: Gastric bypass as treatment for obesity: trends, characteristics, and complications. Obes Res 2005, 13:2202–2209.PubMedCrossRefGoogle Scholar
  14. 14.
    Blackburn GL: Solutions in weight control: lessons from gastric surgery. Am J Clin Nutr 2005, 82:248S–252S.PubMedGoogle Scholar
  15. 15.
    Korner J, Inabnet W, Conwell IM, et al.: Differential effects of gastric bypass and banding on circulating gut hormone and leptin levels. Obesity 2006, 14:1553–1561.PubMedGoogle Scholar
  16. 16.
    Brethauer SA, Chand B, Schauer PR: Risks and benefits of bariatric surgery: current evidence. Clevel Clin J Medicine 2006, 73:993–1007.Google Scholar
  17. 17.
    Buchwald H, Avidor Y, Braunwald E, et al.: Bariatric surgery: a systematic review and meta-analysis. JAMA 2004, 292:1724–1737.PubMedCrossRefGoogle Scholar
  18. 18.
    Skroubis G, Sakellaropoulos G, Pouggouras K, et al.: Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg 2002, 12:551–558.PubMedCrossRefGoogle Scholar
  19. 19.
    Martin L, Chavez GF, Adams MJ, et al.: Gastric bypass as maternal risk factor for neural tube defects. Lancet 1988, 1:640–641.PubMedCrossRefGoogle Scholar
  20. 20.
    Watkins ML, Rasmussen SA, Honein MA, et al.: Maternal obesity and risk for birth defects. Pediatrics 2003, 111:1152–1158.PubMedGoogle Scholar
  21. 21.
    Grange DK, Finlay JL: Nutritional vitamin B12 deficiency in a breastfed infant following maternal gastric bypass. Pediatr Hematol Oncol 1994, 11:311–318.PubMedGoogle Scholar
  22. 22.
    Gurewitsch ED, Levitin MS, Mack J: Pregnancy following gastric bypass surgery for morbid obesity. Obstet Gynecol 1996, 4:658–660.CrossRefGoogle Scholar
  23. 23.
    Dixon JB, Dixon ME, O’Brien PE: Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005, 106:965–972.PubMedGoogle Scholar
  24. 24.
    Huerta S, Rogers LM, Li Z, et al.: Vitamin A deficiency in a newborn resulting from maternal hypovitaminosis A after biliopancreatic diversion for the treatment of morbid obesity. Am J Clin Nutr 2002, 76:426–429.PubMedGoogle Scholar
  25. 25.
    Chang CG, Adams-Huet B, Provost DA: Acute post-gastric reduction surgery (APGARS) neuropathy. Obes Surg 2007, 14:182–189.CrossRefGoogle Scholar
  26. 26.
    Chiossi G, Neri I, Cavazzuti M, et al.: Hyperemesis gravidarum complicated by Wernicke encephalopathy: background; case report; and review of the literature. Obstet Gynecol Surv 2006, 61:255–268.PubMedCrossRefGoogle Scholar
  27. 27.
    Ingardia CJ, Fischer JR: Pregnancy after jejunoileal bypass and the SGA infant. Obstet Gynecol 1978, 52:215–218.PubMedGoogle Scholar
  28. 28.
    Printen KJ, Scott D: Pregnancy following gastric bypass for the treatment of morbid obesity. Am Surg 1982, 48:363–365.PubMedGoogle Scholar
  29. 29.
    Sheiner E, Levy A, Silverberg D, et al.: Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 2004, 190:1335–1340.PubMedCrossRefGoogle Scholar
  30. 30.
    Wittgrove AC, Jester L, Wittgrove P, Clark GW: Pregnancy following gastric bypass for morbid obesity. Obes Surg 1998, 8:461–464.PubMedCrossRefGoogle Scholar
  31. 31.
    Capella RF, Iannace VA, Capella JF: Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg 2006, 203:328–335.PubMedCrossRefGoogle Scholar
  32. 32.
    Kakaria N, Dailey C, Marino T, et al.: Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol 2005, 105:1195–1198.Google Scholar
  33. 33.
    Baker MT, Kothari SN: Successful surgical treatment of a pregnancy-induced Petersen’s hernia after laparoscopic gastric bypass. Surg Obes Relat Dis 2007, 1:506–509.CrossRefGoogle Scholar
  34. 34.
    Ahmed AR, O’Malley W: Internal hernia with Roux loop obstruction during pregnancy after gastric bypass surgery. Obes Surg 2007, 16:1246–1248.CrossRefGoogle Scholar
  35. 35.
    Moore KA, Ouyang DW, Whang EE: Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med 2004, 35:721–722.CrossRefGoogle Scholar
  36. 36.
    Charles A, Domingo S, Goldfadden A, et al.: Small bowel ischemia after Roux-en-Y gastric bypass complicated by pregnancy: a case report. Am Surg 2005, 71:231–234.PubMedGoogle Scholar
  37. 37.
    Martin LF, Finigan KM, Nolan TE: Pregnancy after adjustable gastric banding. Obstet Gynecol 2000, 95(6Pt1):927–930.PubMedCrossRefGoogle Scholar
  38. 38.
    Skull AJ, Slater GH, Duncombe JE, Fielding GA: Laparoscopic adjustable banding in pregnancy: safety; patient tolerance and effect on obesity-related pregnancy outcomes. Obes Surg 2004, 14:230–235.PubMedCrossRefGoogle Scholar
  39. 39.
    Erez O, Maymon E, Mazor M: Acute gastric ulcer perforation in a 35 weeks’ nulliparous patient with gastric banding. Am J Obstet Gynecol 2004, 191:1721–1722.PubMedCrossRefGoogle Scholar
  40. 40.
    Weiss HG, Nehoda H, Labeck B, et al.: Pregnancies after gastric banding. Obes Surg 2001, 11:303–306.PubMedCrossRefGoogle Scholar
  41. 41.
    American College of Obstetricians and Gynecologists: ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol 2005, 106:671–675.Google Scholar
  42. 42.
    Dao T, Kuhn J, Ehmer D, et al.: Pregnancy outcomes after gastric-bypass surgery. Am J Surg 2006, 192:762–766.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Department of OB/GYN and Women’s Health, Division of Maternal-Fetal MedicineWeiler Hospital of Albert Einstein College of MedicineBronxUSA

Personalised recommendations