From the Academy Evidence Analysis Center| Volume 119, ISSUE 11, P1921-1943, November 2019

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Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy—An Evidence Analysis Center Systematic Review

Published:April 27, 2019DOI:



      While obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined.


      A systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy.


      A comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included.

      Main outcome measures

      Outcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores.


      Thirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent.


      Bariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.
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        • Hales C.M.
        • Fryar C.D.
        • Carroll M.D.
        • Freedman D.S.
        • Ogden C.L.
        Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016.
        JAMA. 2018; 319: 1723-1725
        • Marsh C.A.
        • Hecker E.
        Maternal obesity and adverse reproductive outcomes: Reducing the risk.
        Obstet Gynecol Surv. 2014; 69: 622-628
        • Dennedy M.C.
        • Dunne F.
        The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome.
        Best Pract Res Clin Endocrinol Metab. 2010; 24: 573-589
        • Chandrasekaran S.
        • Neal-Perry G.
        Long-term consequences of obesity on female fertility and the health of the offspring.
        Curr Opin Obstet Gynecol. 2017; 29: 180-187
        • Lutsiv O.
        • Mah J.
        • Beyene J.
        • McDonald S.D.
        The effects of morbid obesity on maternal and neonatal health outcomes: A systematic review and meta-analyses.
        Obes Rev. 2015; 16: 531-546
        • Dalfra M.G.
        • Busetto L.
        • Chilelli N.C.
        • Lapolla A.
        Pregnancy and foetal outcome after bariatric surgery: A review of recent studies.
        J Matern Fetal Neonatal Med. 2012; 25: 1537-1543
        • Colquitt J.L.
        • Pickett K.
        • Loveman E.
        • Frampton G.K.
        Surgery for weight loss in adults.
        Cochrane Database Syst Rev. 2014; Aug 8: CD003641
        • le Roux C.W.
        • Heneghan H.M.
        Bariatric surgery for obesity.
        Med Clin North Am. 2018; 102: 165-182
        • Sljivic S.
        • Gusenoff J.A.
        The obesity epidemic and bariatric trends.
        Clin Plast Surg. 2019; 46: 1-7
        • Fuchs H.F.
        • Broderick R.C.
        • Harnsberger C.R.
        • et al.
        Benefits of bariatric surgery do not reach obese men.
        J Laparoendosc Adv Surg Tech A. 2015; 25: 196-201
        • Josefsson A.
        • Blomberg M.
        • Bladh M.
        • Frederiksen S.G.
        • Sydsjo G.
        Bariatric surgery in a national cohort of women: Sociodemographics and obstetric outcomes.
        Am J Obstet Gynecol. 2011; 205: 22
        • Badreldin N.
        • Kuller J.
        • Rhee E.
        • Brown L.
        • Laifer S.
        Pregnancy management after bariatric surgery.
        Obstet Gynecol Surv. 2016; 71: 361-368
        • Dolin C.
        • Ude Welcome A.O.
        • Caughey A.B.
        Management of pregnancy in women who have undergone bariatric surgery.
        Obstet Gynecol Surv. 2016; 71: 734-740
        • Gosman G.G.
        • King W.C.
        • Schrope B.
        • et al.
        Reproductive health of women electing bariatric surgery.
        Fertil Steril. 2010; 94: 1426-1431
        • Galazis N.
        • Docheva N.
        • Simillis C.
        • Nicolaides K.H.
        Maternal and neonatal outcomes in women undergoing bariatric surgery: A systematic review and meta-analysis.
        Eur J Obstet Gynecol Reprod Biol. 2014; 181: 45-53
        • Guelinckx I.
        • Devlieger R.
        • Vansant G.
        Reproductive outcome after bariatric surgery: A critical review.
        Hum Reprod Update. 2009; 15: 189-201
        • Kjær M.M.
        • Nilas L.
        Pregnancy after bariatric surgery—A review of benefits and risks.
        Acta Obstet Gynecol Scand. 2013; 92: 264-271
        • Magdaleno Jr., R.
        • Pereira B.G.
        • Chaim E.A.
        • Turato E.R.
        Pregnancy after bariatric surgery: A current view of maternal, obstetrical and perinatal challenges.
        Arch Gynecol Obstet. 2012; 285: 559-566
        • 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: 420-429
        • Legro R.S.
        Effects of obesity treatment on female reproduction: Results do not match expectations.
        Fertil Steril. 2017; 107: 860-867
        • ACOG Practice Bulletin no
        105: Bariatric surgery and pregnancy.
        Obstet Gynecol. 2009; 113: 1405-1413
        • Handu D.
        • Moloney L.
        • Wolfram T.
        • Ziegler P.
        • Acosta A.
        • Steiber A.
        Academy of Nutrition and Dietetics methodology for conducting systematic reviews for the Evidence Analysis Library.
        J Acad Nutr Diet. 2016; 116: 311-318
        • Johansson K.
        • Cnattingius S.
        • Naslund I.
        • et al.
        Outcomes of pregnancy after bariatric surgery.
        N Engl J Med. 2015; 372: 814-824
        • Kjær M.M.
        • Lauenborg J.
        • Breum B.M.
        • Nilas L.
        The risk of adverse pregnancy outcome after bariatric surgery: A nationwide register-based matched cohort study.
        Am J Obstet Gynecol. 2013; 208: 464.e1-464.e5
        • Berlac J.F.
        • Skovlund C.W.
        • Lidegaard O.
        Obstetrical and neonatal outcomes in women following gastric bypass: A Danish national cohort study.
        Acta Obstet Gynecol Scand. 2014; 93: 447-453
        • Santulli P.
        • Mandelbrot L.
        • Facchiano E.
        • et al.
        Obstetrical and neonatal outcomes of pregnancies following gastric bypass surgery: A retrospective cohort study in a French referral centre.
        Obes Surg. 2010; 20: 1501-1508
        • Shai D.
        • Shoham-Vardi I.
        • Amsalem D.
        • Silverberg D.
        • Levi I.
        • Sheiner E.
        Pregnancy outcome of patients following bariatric surgery as compared with obese women: A population-based study.
        J Matern Fetal Neonatal Med. 2014; 27: 275-278
        • Burke A.E.
        • Bennett W.L.
        • Jamshidi R.M.
        • et al.
        Reduced incidence of gestational diabetes with bariatric surgery.
        J Am Coll Surg. 2010; 211: 169-175
        • Gadgil M.D.
        • Chang H.Y.
        • Richards T.M.
        • et al.
        Laboratory testing for and diagnosis of nutritional deficiencies in pregnancy before and after bariatric surgery.
        J Womens Health. 2014; 23: 129-137
        • Lapolla A.
        • Marangon M.
        • Dalfra M.G.
        • et al.
        Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding.
        Obes Surg. 2010; 20: 1251-1257
        • Marceau P.
        • Kaufman D.
        • Biron S.
        • et al.
        Outcome of pregnancies after biliopancreatic diversion.
        Obes Surg. 2004; 14: 318-324
        • Weintraub A.Y.
        • Levy A.
        • Levi I.
        • Mazor M.
        • Wiznitzer A.
        • Sheiner E.
        Effect of bariatric surgery on pregnancy outcome.
        Int J Gynaecol Obstet. 2008; 103: 246-251
        • Ducarme G.
        • Revaux A.
        • Rodrigues A.
        • Aissaoui F.
        • Pharisien I.
        • Uzan M.
        Obstetric outcome following laparoscopic adjustable gastric banding.
        Int J Gynaecol Obstet. 2007; 98: 244-247
        • Lesko J.
        • Peaceman A.
        Pregnancy outcomes in women after bariatric surgery compared with obese and morbidly obese controls.
        Obstet Gynecol. 2012; 119: 547-554
        • Patel J.A.
        • Patel N.A.
        • Thomas R.L.
        • Nelms J.K.
        • Colella J.J.
        Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2008; 4: 39-45
        • Araujo Junior E.
        • Peixoto A.B.
        • Zamarian A.C.
        • Elito Junior J.
        • Tonni G.
        Macrosomia. Best Pract Res Clin Obstet Gynaecol. 2017; 38: 83-96
        • Hughes M.M.
        • Black R.E.
        • Katz J.
        2500-g low birth weight cutoff: History and implications for future research and policy.
        Matern Child Health J. 2017; 21: 283-289
        • Hinkle S.N.
        • Albert P.S.
        • Mendola P.
        • et al.
        Differences in risk factors for incident and recurrent small-for-gestational-age birthweight: A hospital-based cohort study.
        BJOG. 2014; 121: 1080-1088
        • Institute of Medicine
        Weight Gain During Pregnancy: Reexamining the Guidelines.
        National Academies Press, Washington, DC2009
        • Goldstein R.
        • Teede H.
        • Thangaratinam S.
        • Boyle J.
        Excess gestational weight gain in pregnancy and the role of lifestyle intervention.
        Semin Reprod Med. 2016; 34: e14-e21
        • Yau P.O.
        • Parikh M.
        • Saunders J.K.
        • Chui P.
        • Zablocki T.
        • Welcome A.U.
        Pregnancy after bariatric surgery: The effect of time-to-conception on pregnancy outcomes.
        Surg Obes Relat Dis. 2017; 13: 1899-1905
        • Buchwald H.
        • Buchwald J.N.
        • McGlennon T.W.
        Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass.
        Obes Surg. 2014; 24: 1536-1551
        • Simmons D.
        Diabetes and obesity in pregnancy.
        Best Pract Res Clin Obstet Gynaecol. 2011; 25: 25-36
        • Durnwald C.
        Gestational diabetes: Linking epidemiology, excessive gestational weight gain, adverse pregnancy outcomes, and future metabolic syndrome.
        Semin Perinatol. 2015; 39: 254-258
        • von Dadelszen P.
        • Magee L.A.
        Pre-eclampsia: An update.
        Curr Hypertens Rep. 2014; 16: 454
        • Kwong W.
        • Tomlinson G.
        • Feig D.S.
        Maternal and neonatal outcomes after bariatric surgery; A systematic review and meta-analysis: Do the benefits outweigh the risks?.
        Am J Obstet Gynecol. 2018; 218: 573-580
        • Cheung N.W.
        • Moses R.G.
        Gestational diabetes mellitus: Is it time to reconsider the diagnostic criteria?.
        Diabetes Care. 2018; 41: 1337-1338
        • Witt W.P.
        • Wisk L.E.
        • Cheng E.R.
        • et al.
        Determinants of cesarean delivery in the U.S.: A lifecourse approach.
        Matern Child Health J. 2015; 19: 84-93
        • Kominiarek M.A.
        Pregnancy after bariatric surgery.
        Obstet Gynecol Clin North Am. 2010; 37: 305-320
        • Chu S.Y.
        • Kim S.Y.
        • Schmid C.H.
        • et al.
        Maternal obesity and risk of cesarean delivery: A meta-analysis.
        Obes Rev. 2007; 8: 385-394
        • Leung T.Y.
        • Lao T.T.
        Timing of caesarean section according to urgency.
        Best Pract Res Clin Obstet Gynaecol. 2013; 27: 251-267
        • Cutland C.L.
        • Lackritz E.M.
        • Mallett-Moore T.
        • et al.
        Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data.
        Vaccine. 2017; 35: 6492-6500
        • Carreau A.M.
        • Nadeau M.
        • Marceau S.
        • Marceau P.
        • Weisnagel S.J.
        Pregnancy after bariatric surgery: Balancing risks and benefits.
        Can J Diabetes. 2017; 41: 432-438
        • Boney C.M.
        • Verma A.
        • Tucker R.
        • Vohr B.R.
        Metabolic syndrome in childhood: Association with birth weight, maternal obesity, and gestational diabetes mellitus.
        Pediatrics. 2005; 115: e290-e296
        • Nader P.R.
        • O'Brien M.
        • Houts R.
        • et al.
        Identifying risk for obesity in early childhood.
        Pediatrics. 2006; 118: 2005-2801
        • Sacco M.R.
        • de Castro N.P.
        • Euclydes V.L.
        • Souza J.M.
        • Rondo P.H.
        Birth weight, rapid weight gain in infancy and markers of overweight and obesity in childhood.
        Eur J Clin Nutr. 2013; 67: 1147-1153
        • Parent B.
        • Martopullo I.
        • Weiss N.S.
        • Khandelwal S.
        • Fay E.E.
        • Rowhani-Rahbar A.
        Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications.
        JAMA Surg. 2017; 152: 128-135
        • Hong Y.H.
        • Chung S.
        Small for gestational age and obesity related comorbidities.
        Ann Pediatr Endocrinol Metab. 2018; 23: 4-8
        • Katz J.
        • Lee A.C.
        • Kozuki N.
        • et al.
        Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: A pooled country analysis.
        Lancet. 2013; 382: 417-425
        • Santarpia L.
        • Grandone I.
        • Alfonsi L.
        • Sodo M.
        • Contaldo F.
        • Pasanisi F.
        Long-term medical complications after malabsorptive procedures: Effects of a late clinical nutritional intervention.
        Nutrition. 2014; 30: 1301-1305
        • Ye J.
        • Zhang L.
        • Chen Y.
        • Fang F.
        • Luo Z.
        • Zhang J.
        Searching for the definition of macrosomia through an outcome-based approach.
        PLoS One. 2014; 9
        • Johnson S.
        • Marlow N.
        Early and long-term outcome of infants born extremely preterm.
        Arch Dis Child. 2017; 102: 97-102
        • Loftin R.W.
        • Habli M.
        • Snyder C.C.
        • Cormier C.M.
        • Lewis D.F.
        • DeFranco E.A.
        Late preterm birth.
        Rev Obstet Gynecol. 2010; 3: 10-19
        • Shapiro-Mendoza C.K.
        • Lackritz E.M.
        Epidemiology of late and moderate preterm birth.
        Semin Fetal Neonatal Med. 2012; 17: 120-125
        • van der Zande I.S.E.
        • van der Graaf R.
        • Oudijk M.A.
        • van Delden JJM
        Vulnerability of pregnant women in clinical research.
        J Med Ethics. 2017; 43: 657-663


      R. I. Al-Nimr is director, Nutrition in Medical Education Program, and a clinical instructor in medicine and medical education, The Geisel School of Medicine, Dartmouth College, Hanover, NH; and a clinical dietitian in research, Dartmouth-Hitchcock Medical Center, Lebanon, NH.


      R. Hakeem is a principal, Raana Liaqat Ali Khan Government College of Home Economics, Karachi, Pakistan.


      J. M. Moreschi is a regional extension educator, Supplemental Nutrition Assistance Program Education, Northwest Region, Ottawa, IL.


      S. Gallo is an assistant professor, Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, VA.


      J. M. McDermid is an assistant professor, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville.


      M. Pari-Keener is a clinical dietitian, Outpatient Clinic, Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.


      B. Stahnke is a Special Supplemental Nutrition Program for Women, Infants, and Children advisory team manager, Georgia Department of Health, Division of Health Promotion, Georgia Special Supplemental Nutrition Program for Women, Infants, and Children Program, Program Integrity and Strategy Unit, Atlanta.


      C. Papoutsakis is senior director, Nutrition and Dietetics Data Science Center, Research, International, and Scientific Affairs, Chicago, IL.


      D. Handu is the senior scientific director, Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL.


      F. W. Cheng is a nutrition researcher, Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL.