Abstract
Introduction
To compare the gestational weight gain (GWG) between women with previous bariatric surgery and those without and investigate whether GWG correlates with birthweight (BW) or delivery of a small-for-gestational-age (SGA) neonate.
Materials and Methods
Prospective, longitudinal study, include 100 pregnant women with previous bariatric surgery and 100 without weight loss surgery, but with similar early-pregnancy body mass index (BMI). In a sub-study, 50 of the post-bariatric women were also matched to 50 women without surgery, but early-pregnancy BMI similar to the pre-surgery BMI of the post-bariatric ones. All women had their weight/BMI measured at 11–14 and 35–37 weeks of gestation, and the difference in maternal weight/BMI between the two time points was expressed as GWG/BMI gain. Associations between maternal GWG/BMI gain and birthweight (BW) were examined.
Results
Compared to no bariatric women with similar early-pregnancy BMI, post-bariatric women had similar GWG (p = 0.46), and the number of women with appropriate, insufficient, and excessive weight gain was comparable between groups (p = 0.76). However, post-bariatric women delivered smaller babies (p < 0.001), and GWG was not a significant predictor of BW or of delivering a SGA neonate. Compared to no bariatric women with similar pre-surgery BMI, post-bariatric ones had higher GWG (p < 0.01) but still delivered smaller neonates (p = 0.001).
Conclusions
Post-bariatric women seem to have similar or greater GWG compared to women without surgery matched for early-pregnancy or pre-surgery BMI, respectively. Maternal GWG was not associated with BW or higher prevalence of SGA neonates seen in women with previous bariatric surgery.
Graphical Abstract
![](http://media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs11695-023-06496-4/MediaObjects/11695_2023_6496_Figa_HTML.png)
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
The global pandemic of obesity is on the rise and has nearly tripled from 1975–2016 with 39% of the global adult population being overweight [1]. In 2019, a health survey for England deemed 31% of women overweight and 29% obese [2], whereas in the US 1 in 2 women of childbearing age are classified as either overweight or obese [3]. Obesity in pregnancy is associated with an increased risk of adverse outcomes such as pre-eclampsia (PE), gestational diabetes mellitus (GDM), large-for-gestational-age (LGA) neonates, emergency Caesarean section, and stillbirth [4,5,6]. In contrast, pregnant women with low body mass index (BMI) are at increased risk of preterm birth and delivery of small-for-gestational-age (SGA) neonates [7]. Apart from the importance of booking BMI, emphasis has also been given on the role of gestational weight gain (GWG) in pregnancy outcomes [8, 9]. The general consensus on the optimal GWG is based on the Institute of Medicine (IOM) guidelines which state that pregnant women with normal BMI (18.5–24.9 kg/m2), overweight (BMI = 25–29.9 kg/m2), and obese (BMI ≥ 30 kg/m2) should gain 11.5–16 kg, 7–11.5 kg, and 5–9 kg, respectively [8]. Women who gain weight according to IOM guidelines are more likely to have better maternal and perinatal outcomes [10], including reduced rates of LGA and SGA neonates and reduced incidence of maternal hypertension, Caesarean section, and neonatal hypoglycaemia [11]. Inadequate GWG has been shown to increase the risk of having a SGA neonate, particularly in underweight women, whereas excessive GWG, combined with a raised maternal BMI, has been shown to increase the risk of a LGA neonate and low Apgar scores but decrease the risk of delivering a SGA neonate [12].
The dramatic increase in rates of obesity has led to an increase in demand for bariatric surgery, which is the most successful treatment for long-lasting weight loss and obesity related co-morbidities [13]. Worldwide, approximately 70–80% of patients undergoing bariatric surgery are women [14, 15] with up to 40% of them being of childbearing age [15, 16], meaning that an increasing number of these patients are likely to require antenatal care. Studies have suggested that pregnancy following bariatric surgery is associated with lower rates of LGA neonates but increased rates of SGA neonates and preterm delivery, compared to pregnancies in women with no surgery but booking BMI similar to the early-pregnancy or pre-surgery BMI of the post-bariatric ones [17]. A relatively small number of studies have investigated the effects of maternal GWG on the outcome of post-bariatric pregnancies, and especially on birthweight (BW) and increased rates of SGA neonates, seen in this population [18,19,20,21,22,23,24]. However, most of these studies were retrospective and therefore unable to evaluate reliably the role of GWG in this population.
The aim of the current study was to investigate, prospectively, the impact of GWG on pregnancy outcomes in women with previous bariatric surgery and also compare it to those of women without history of weight loss surgery.
Material and Methods
This study was part of a larger prospective, longitudinal study investigating the impact of bariatric surgery on maternal and perinatal outcomes. The study protocol has been previously published [25, 26]. In brief, women with previous bariatric surgery, and those without, were recruited in the first trimester of pregnancy and seen at five time points during pregnancy (11–14, 20–24, 28–30, 30–32, 35–37 weeks) and at delivery. At recruitment, maternal characteristics such as age, parity, ethnicity, method of conception, smoking status, previous medical/obstetric history, and details of bariatric surgery (where applicable) were recorded in our research database. All pregnancies were singletons and dated by crown-rump length. At each encounter, maternal weight, to the nearest 0.1 kg using a calibrated electronic scale (Marsden Scales), and height, to the nearest 0.5 cm, were measured with the women in light clothing and without shoes. These measurements were used to calculate the maternal BMI (kg/m2) at each visit. All women underwent screening for GDM at 28–30 weeks of gestation; all no surgery patients underwent a 75 g, 2-h oral glucose tolerance test (OGTT), and GDM was diagnosed according to NICE guidelines [27]. All post-bariatric women had fasting blood glucose levels measured and 2 weeks of home glucose monitoring. Hypertensive disorders in pregnancy (BP ≥ 140/90 + / − proteinuria) were diagnosed and managed as per NICE guidelines [28]. All women delivered a live, phenotypically normal neonate. Data on pregnancy outcome were obtained from the hospital records. The neonatal BW was measured to the nearest gram, soon after delivery, using an electronic weighing scale (Seca Model 384, Germany), and BW percentiles were calculated based on gestational age at delivery and BW [29]. Small-for-gestational-age and LGA neonates were defined as delivery of a neonate with BW < 10th and > 90th percentile, respectively.
Post-bariatric pregnant women were matched with women, with no history of bariatric surgery, but with similar early-pregnancy BMI. In a sub-study, some of the post-bariatric women were matched to no surgery women with booking BMI similar to their pre-surgery BMI. Women were also matched for age, ethnic group, and parity. We only included women who had their weight/BMI measured in the first (11–14 weeks) and third (35–37 weeks) trimester of pregnancy. Gestational weight gain was calculated by subtracting the weight at 11–14 weeks from the weight at 35–37 weeks giving the total GWG. The total GWG was also categorized into appropriate, insufficient, or excessive, as per IOM classification [13]. Using the above calculations, the total BMI gain was also calculated. For post-bariatric women only, we calculated the surgery to conception interval, as the time (in months) between surgery and conception which was defined as the 14th day of pregnancy, and weight loss, expressed as BMI (kg/m2) loss from pre-surgery (self-reported) to the first trimester of pregnancy. The study was approved by the West London Research Ethics Committee (No: 14/LO0592-2014 on 03/06/2014), and all women gave written informed consent.
Statistical Analysis
Normality of the distribution of the data was examined with the Kolmogorov–Smirnov test. Logarithmic transformation was performed for no normally distributed data. Data were expressed as mean (standard deviation (SD)) or as median (interquartile range) for normally and no normally distributed data, respectively. Comparisons between groups were performed using unpaired Student’s t-test/Mann–Whitney U-test or chi-square test for numerical and categorical data, respectively. Pearson’s correlation was used to examine the relation between maternal characteristics and BW. Using the significant predictors, a multiple regression was then created to evaluate which factors remained significant predictors of BW. Binomial logistic regression was used to derive the association between maternal characteristics, including GWG, and delivery of a SGA neonate. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS for Windows 2019, version 26.0, IBM Corp., Armonk, New York, US), and differences were considered significant at p < 0.05.
Results
The study period was from May 2015 to March 2021 and included 100 post-bariatric pregnant women who were matched to 100 pregnant women with no weight loss surgery history but with similar early-pregnancy BMI. The post-bariatric group included 21 women who had undergone a gastric band procedure, 30 with sleeve gastrectomy, and 49 with gastric bypass. The mean surgery to conception interval was approximately 4.5 years (55.89 (36.13) months) and only 8 women conceived within 12 months of the surgery. The mean BMI loss was 12.18 (6.32) kg/m2. The demographic characteristics, biophysical profile, and pregnancy outcomes of the study participants, according to the type of surgery performed, are given in Table 1.
The total GWG and BMI gain (12 to 36 weeks) was comparable between the groups (Table 1). Likewise, the number of women who had appropriate, insufficient, and excessive GWG, according to IOM, was similar between the groups and among women with different types of bariatric surgery. In the post-bariatric group, there was no significant difference in surgery to conception interval between women with appropriate, insufficient, or excessive GWG (p = 0.96). Despite similar GWG, post-bariatric women (especially those that had undergone a sleeve gastrectomy or a gastric bypass) delivered smaller babies and tended to have more SGA and less LGA babies, although these differences did not reach a significance in our population. The Pearson correlation revealed that maternal age (p < 0.01), ethnic group (p = 0.07), total GWG (p < 0.05), previous bariatric surgery (p < 0.01), and gestational age at delivery (p < 0.01) were significant determinants of BW, whereas maternal smoking (p = 0.54), method of conception (p = 0.46), parity (p = 0.35), presence of diabetes (p = 0.45), or hypertensive disorders (p = 0.41) were not. Using only the significant predictors, a multiple regression was then constructed, and maternal ethnic group (p = 0.09), previous bariatric surgery (p < 0.01), and gestational age at delivery (p < 0.01) remained significant predictors of BW, whereas maternal age and GWG were not. The results were unchanged when, instead of GWG (in kg), maternal BMI gain or GWG (according to IOM category) were considered. Furthermore, insufficient or excessive GWG, according to IOM guidelines, was not an independent predictor of delivering a neonate that was SGA or LGA, respectively. We then considered the groups separately and, in the no surgery group, we found that although GWG, as a continuous variable, was not associated with BW (p = 0.27), insufficient GWG was a significant independent predictor of delivering a SGA neonate (p = 0.02) (Table 3). In the post-bariatric group as a whole, we also found no association between maternal GWG and BW (p = 0.52), and this was the case even if when different types of surgery were considered separately (p = 0.67, p = 0.93, and p = 0.61 for women with a gastric band, sleeve gastrectomy, and gastric bypass, respectively). We also found no correlation between insufficient GWG and delivery of a SGA neonate in the post-bariatric group, as a whole (Table 3), or when women with a gastric band (p = 0.29), sleeve gastrectomy (p = 0.71), and gastric bypass (p = 0.75) were considered separately. Additionally, there was no independent association (in the whole cohort or in the groups separately) between GWG and gestational age at delivery (p = 0.12), when maternal characteristics such as age, parity, method of conception, and presence of diabetes were taken into account.
In the sub-study, 50 post-bariatric (12 with gastric band, 13 with gastric sleeve, and 25 with gastric bypass) pregnant women were matched to 50 women with no surgery but with early-pregnancy BMI similar to the pre-surgery BMI of the post-bariatric ones (43.90 (7.35) kg/m2 vs 43.19 (7.53) kg/m2; p = 0.63). For post-bariatric women, the mean surgery to conception interval was almost 4.5 years (53.42 (31.40) months), and the mean BMI loss was 11.69 (7.19) kg/m2. The demographic characteristics, biophysical profile, and pregnancy outcomes of the study participants are given in Table 2. Post-bariatric women were more likely to be smokers and had lower weight/BMI at both time points (first and third trimesters), as expected, but gained more weight/BMI during pregnancy. Although, post-bariatric women gained more weight, they still delivered smaller babies and tended to have higher rates of SGA and lower rates of LGA neonates. Pearson correlation showed that in the whole sub-study cohort, maternal age (p < 0.01), previous bariatric surgery (p = 0.01), and gestational age at delivery (p < 0.01) were significant predictors of BW, but maternal ethnic group (p = 0.9), smoking (p = 0.16), method of conception (p = 0.11), parity (p = 0.82), total GWG (p = 0.78), presence of diabetes (p = 0.36), and hypertensive disorders (p = 0.19) were not. Using only the significant predictors, a multiple regression showed that previous maternal bariatric surgery (p < 0.01) and gestational age at delivery (p < 0.01) remained significant independent predictors of BW. In the whole sub-study cohort, insufficient or excessive GWG was not an independent predictor of delivering a SGA or LGA neonate, respectively. We did not consider the no surgery and post-bariatric groups separately, as due to the small sample size, we could not compute the association of GWG categories with the risk of delivering a SGA or LGA neonate; none of the SGA infants was born in post-bariatric women with insufficient GWG (Table 3). Moreover, there was no independent association between GWG and gestational age at delivery (p = 0.80) when maternal characteristics were considered.
Discussion
This prospective observational study has demonstrated that the trimester-specific GWG of post-bariatric and no surgery women, matched for early-pregnancy weight/BMI, is similar. Nevertheless, the former group delivered smaller neonates. Furthermore, the distribution of women who gained appropriate, insufficient, or excessive weight during pregnancy, according to IOM guidelines, was comparable in both groups. Maternal GWG was not associated with BW, and although insufficient GWG was a significant predictor of delivering a SGA in the no surgery group, this was not the case in the post-bariatric group. When post-bariatric pregnant women were compared to women with early-pregnancy weight/BMI similar to their pre-surgery weight/BMI, we found that the former group had greater GWG but still delivered smaller neonates.
Gestational weight gain has generally been shown to have an impact on pregnancy outcomes. A recent meta-analysis including more than one million pregnant women has demonstrated that insufficient GWG was associated with higher risk of having a SGA neonate and preterm birth, whereas excessive GWG was associated with increased risk of LGA neonates, macrosomia, Caesarean delivery, and reduced risk of SGA and preterm delivery [9]. In consistence with that report, we found that insufficient GWG was associated with increased risk of delivering a SGA neonate but only in the no surgery group. In contrast, maternal insufficient GWG was not associated with the delivery of a SGA neonate in the post-bariatric group. Most of the studies on GWG in post-bariatric pregnant women are retrospective; reported maternal weight at different gestational weeks/times or “the last known weight of pregnancy”; used different control groups, if any; and reported conflicting results [18,19,20,21,22,23,24]. One retrospective study examining the effect of trimester-specific GWG on BW, in women with previous biliopancreatic diversion, found that although women had less GWG, compared to women without surgery, there was still no association between GWG and BW [19]. Other retrospective studies, including women with laparoscopic adjustable gastric banding, sleeve gastrectomy, or gastric bypass, showed similar GWG between post-bariatric and no surgery women [20, 21] when a control group was used, but then again, there was lack of an association between GWG and risk of delivering a SGA neonate [20, 22]. In contrast, other retrospective studies have shown an association between GWG and BW [18, 24]. The only prospective study in women with previous bariatric surgery has reported an association between insufficient GWG, defined as the difference between “measured weight at the time of childbirth” and self-reported pre-conception weight, and delivery of a SGA neonate, as well as preterm birth [23]. However, the study did not include a no surgery comparative group, and the lack of standardization of the gestation at which the maternal weight was measured may have introduced bias, as women who delivered earlier had, certainly, less GWG compared to the ones who delivered later. Conversely, in our study we calculated the GWG using a standardized approach of measuring the maternal weight at 12 and 36 weeks, for all patients.
In our study, women with previous bariatric surgery delivered significantly smaller babies and had more SGA and less LGA neonates, compared to women with no surgery, even if these differences did not always reach statistical significance. Maternal GWG does not seem to play a role in determining BW in the post-bariatric group, and therefore, it is probable that, in this group, other mechanisms are involved, including specific maternal nutritional deficiencies and/or alteration of the maternal metabolic/glucose environment [25, 26, 30]. However, nutritional levels of post-bariatric women with small and normal size neonates are reported to be similar [31]. Furthermore, if GWG is used as a surrogate for the general maternal nutritional status and considering that, in our study, post-bariatric women had similar or even greater GWG, than their relevant counterparts, then it is unlikely that nutrition will be proven to be a key determinant of BW. However, maternal glucose levels/variation appears more likely to play a role in determining the BW in this high-risk population. Of note, pregnant women with previous bariatric surgery have been shown to have lower fasting glucose and insulin resistance levels, compared to women without surgery, and these levels have been positively associated with BW and body fat deposition of their offspring [25, 26].
In our study, the proportion of post-bariatric women who gained insufficient weight was 28%, which is similar to the proportion reported in another prospective study [23] but lower to what has been reported in other studies [14, 19]. This may be due to the fact that most of our post-bariatric participants conceived many years after the surgery and therefore were not in the catabolic, post-operative phase, which has been associated with insufficient GWG [32], or because most of the previous studies included women from more than a decade ago, when the antenatal care may not have been as optimal as it is at present times.
Our study was a single-center, prospective, longitudinal study that used robust methodology in reporting the maternal weight at specific times in pregnancy, from the first to the third trimester, and under controlled conditions. By including the maternal weight at 36 weeks, we excluded, by definition, all women that may have delivered earlier, and therefore, we were not able to assess comprehensively the potential effect of GWG on the risk of preterm delivery. The groups were closely matched not only in terms of weight/BMI but other maternal characteristics, which allowed us to minimize the impact of known confounders. The relatively small number of post-bariatric women may have prevented us from determining the effect of GWG on BW according to the type of surgery performed. Although we suggest that maternal nutrition is unlikely to affect BW, we were unable to confirm this in our population. Of note, all post-bariatric women and those with no surgery and booking BMI ≥ 35 kg/m2 received dietary advice and approximately 50% of the former and 66% of the latter group were on prenatal multivitamin supplementation in the first trimester, which reduced to 27% and 35%, respectively, by the third trimester. The rest of the women took prenatal vitamins separately, including folate, vitamin D, vitamin B12, and vitamin C. Furthermore, food, calorie intake, and physical activity diaries were not recorded during our study.
In conclusion, this prospective study has shown that pregnant women with previous bariatric surgery have similar or greater GWG compared to no surgery pregnant women matched for early-pregnancy and pre-surgery BMI, respectively. However, the GWG of post-bariatric women does not seem to be associated with BW or the higher prevalence of SGA neonates seen in this population. Furthermore, studies are required to investigate the determinants of BW in this high-risk group.
Data Availability
The data that support this study are available on request from the corresponding author.
References
Krzysztoszek J, Laudanska-Krzeminska I, Bronikowski M. Assessment of epidemiological obesity among adults in EU countries. Ann Agric Environ Med. 2019; 26(2). Available from: https://agro.icm.edu.pl/agro/element/bwmeta1.element.agro-d8e56603-5968-4214-9529-f2ced9ce6b07. Accessed 7 Mar 2022
Obesity. The Nuffield Trust. 2019. Available from: https://www.nuffieldtrust.org.uk/resource/obesity. Accessed 7 Mar 2022
Vahratian A. Prevalence of overweight and obesity among women of childbearing age. Matern Child Health J. 2009;13(2):268–73.
Kazemian E, Sotoudeh G, Dorosty-Motlagh AR, et al. Maternal obesity and energy intake as risk factors of pregnancy-induced hypertension among Iranian women. J Health Popul Nutr. 2014;32(3):486–93.
Doherty DA, Magann EF, Francis J, et al. Pre-pregnancy body mass index and pregnancy outcomes. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2006;95(3):242–7.
HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.
Han Z, Mulla S, on behalf of the Knowledge Synthesis Group, et al. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol. 2011;40(1):65–101.
Institute of Medicine (US) and National Research Council (US) Committee to reexamine IOM pregnancy weight guidelines. Weight gain during pregnancy: reexamining the guidelines. Rasmussen KM, Yaktine AL, editors. Washington (DC): National Academies Press (US); 2009. (The National Academies Collection: Reports funded by National Institutes of Health). Available from: http://www.ncbi.nlm.nih.gov/books/NBK32813/. Accessed 7 Mar 2022
Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–25.
Siega-Riz AM, Viswanathan M, Moos M-K, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339.e1-14.
Bouvier D, Forest J-C, Dion-Buteau E, et al. Association of maternal weight and gestational weight gain with maternal and neonate outcomes: a prospective cohort study. J Clin Med. 2019;8(12):2074.
Nohr EA, Vaeth M, Baker JL, et al. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008;87(6):1750–9.
Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020;324(9):879.
Young MT, Phelan MJ, Nguyen NT. A decade analysis of trends and outcomes of male vs female patients who underwent bariatric surgery. J Am Coll Surg. 2016;222(3):226–31.
Quyên Pham T, Pigeyre M, Caiazzo R, et al. Does pregnancy influence long-term results of bariatric surgery? Surg Obes Relat Dis. 2015;11(5):1134–9.
Hutchesson MJ, de JongeMulockHouwer M, Brown HM, et al. Supporting women of childbearing age in the prevention and treatment of overweight and obesity: a scoping review of randomized control trials of behavioral interventions. BMC Womens Health. 2020;20(1):14.
Roos N, Neovius M, Cnattingius S, et al. Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study. BMJ. 2013;347:f6460.
Grandfils S, Demondion D, Kyheng M, et al. Impact of gestational weight gain on perinatal outcomes after a bariatric surgery. J Gynecol Obstet Hum Reprod. 2019;48(6):401–5.
Gagnon G, Carreau A-M, Cloutier-Langevin C, et al. Trimester-specific gestational weight gain in women with and without previous bariatric surgeries. Eur J Obstet Gynecol Reprod Biol. 2022;270:252–8.
Hammeken LH, Betsagoo R, Jensen AN, et al. Nutrient deficiency and obstetrical outcomes in pregnant women following Roux-en-Y gastric bypass: a retrospective Danish cohort study with a matched comparison group. Eur J Obstet Gynecol Reprod Biol. 2017;216:56–60.
Lapolla A, Marangon M, Dalfrà MG, et al. Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding. Obes Surg. 2010;20(9):1251–7.
Sancak S, Altun H, Çeler Ö, et al. Impact of gestational weight gain on maternal and perinatal outcomes after laparoscopic sleeve gastrectomy. Obes Surg. 2022. https://doi.org/10.1007/s11695-022-06305-4.
Ceulemans D, De Mulder P, Lebbe B, et al. Gestational weight gain and postpartum weight retention after bariatric surgery: data from a prospective cohort study. Surg Obes Relat Dis. 2021;17(4):659–66.
Berglind D, Willmer M, Näslund E. Differences in gestational weight gain between pregnancies before and after maternal bariatric surgery correlate with differences in birth weight but not with scores on the body mass index in early childhood. Pediatr Obes. 2014;9(6):427–34.
Maric T, Kanu C, Johnson MR, et al. Maternal, neonatal insulin resistance and neonatal anthropometrics in pregnancies following bariatric surgery. Metabolism. 2019;97:25–31.
Maric T, Kanu C, Muller D, et al. Fetal growth and fetoplacental circulation in pregnancies following bariatric surgery: a prospective study. BJOG Int J Obstet Gynaecol. 2020;127(7):839–46.
Recommendations | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE. Available from: https://www.nice.org.uk/guidance/ng3/chapter/Recommendations#gestational-diabetes. Accessed 7 March 2022
Overview | Hypertension in pregnancy: diagnosis and management | Guidance | NICE. Available from: https://www.nice.org.uk/guidance/ng133. Accessed 7 Mar 2022
Nicolaides KH, Wright D, Syngelaki A, et al. Fetal Medicine Foundation fetal and neonatal population weight charts. Ultrasound Obstet Gynecol. 2018;52(1):44–51.
Jans G, Matthys C, Bogaerts A, et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Adv Nutr. 2015;6(4):420–9.
Akhter Z, Heslehurst N, Ceulemans D, et al. Pregnancy after bariatric surgery: a nested case-control study of risk factors for small for gestational age babies in AURORA. Nutrients. 2021;13(5):1699.
Heusschen L, Krabbendam I, van der Velde JM, et al. A matter of timing-pregnancy after bariatric surgery. Obes Surg. 2021;31(5):2072–9.
Acknowledgements
The authors would like to thank Dr Chidimma Kanu and Allessandra Rocco for their assistance in the data collection. The authors would also like to thank all women taking part in the study.
Funding
The study was supported by CW + (CWPLUS Registered Charity No 1169897).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Key Points
• Pregnant women with previous bariatric surgery have comparable gestational weight gain to no bariatric women, with similar early-pregnancy BMI, but still deliver smaller neonates.
• Gestational weight gain in post-bariatric pregnant women does not seem to be associated with birthweight.
• Gestational weight gain in post-bariatric pregnant women does not seem to be associated with the delivery of a small-for-gestational-age neonate in this group.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Iacovou, C., Maric, T., Bourke, M. et al. Gestational Weight Gain in Pregnancies Following Bariatric Surgery. OBES SURG 33, 1004–1011 (2023). https://doi.org/10.1007/s11695-023-06496-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-023-06496-4