Retrospective Analysis of Pregnancy Following Bariatric Surgery

Retrospective Analysis of Pregnancy Following Bariatric Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retrospective Analysis of Pregnancy Following Bariatric Surgery Zhong Qi, Xiao-Chen Shi, Ri-Xing Bai, Wen-Mao Yan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6850277/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Obesity increases the risk of infertility, gestational diabetes, and hypertension. While weight loss reduces these risks, it may increase the incidence of small-for-gestational-age (SGA) infants. To investigate the effects and safety of pregnant women and neonates during pregnancy and delivery after bariatric surgery. Method A retrospective analysis was conducted on 43 women who conceived naturally after bariatric surgery at ** hospital between January 2012 and December 2021, with 24 providing complete data. The parameters included patient body mass index, postoperative pregnancy interval, maternal blood pressure and glucose levels, maternal nutritional status throughout pregnancy, mode of delivery, and neonatal outcomes such as birth weight, length, Apgar score, presence of deformities, mortality, and the need for NICU monitoring. Results Five patients underwent Roux-en-Y gastric bypass (RYGB), and 19 underwent laparoscopic sleeve gastrectomy (LSG). The average prepregnancy total weight loss (TWL) was 26.85%. During pregnancy, 45.83% of the patients developed anemia, and 16.67% of the patients experienced insufficient weight gain during pregnancy. Preoperatively, 10 of the patients had comorbid type 2 diabetes, and 8 had comorbid hypertension, which was controlled postoperatively. However, diabetes recurred in 70% of the patients during pregnancy, with the recurrence rate in the LSG group being higher than that in the RYGB group, and hypertension recurred in 50% of the patients. No neonatal deaths or NICU admissions were observed. The rate of preterm birth was 4.35%, which is below average. The incidence of smaller-for-gestational-age infants was 12.5%, occurring exclusively in pregnancies with insufficient gestational weight gain, especially after RYGB. Conclusions Pregnancy after bariatric surgery is relatively safe, reducing obesity-related complications. However, LSG may be preferable for patients with obesity who are planning pregnancy, and a waiting period is advised until their weight stabilizes. Indicators such as weight, blood pressure, blood sugar, and nutritional status should be closely monitored during pregnancy. Bariatric surgery pregnancy diabetes mellitus hypertension neonatal complications INTRODUCTION Obesity has reached epidemic proportions globally, with over 50% of adults in China now classified as overweight or obese. [ 1 ] Obesity is often comorbid with diseases such as type 2 diabetes, hypertension, and dyslipidemia, which pose multiple levels of threats to patients, and has become the sixth cause of death from chronic noncommunicable diseases in China. [ 2 ] Obesity is a risk factor for various conditions, including infertility, gestational diabetes, and gestational hypertension. Moreover, it increases the incidence of macrosomia, cesarean section, miscarriage, premature birth, etc., which seriously affects maternal and fetal health. Weight loss can effectively reduce the incidence of the above diseases but may increase the incidence of smaller for gestational age (SGA) infants. Bariatric surgery has emerged as an effective intervention for obesity and its complications and can effectively regulate weight, blood sugar, and blood pressure. In China, 70% of bariatric surgery patients are women, with a median age of 32 years, [ 3 ] making it a demographic comprising mostly women of childbearing age. Considering the limited clinical data on pregnancy after bariatric surgery in China, a retrospective analysis was conducted on the clinical and pregnancy data of patients who conceived naturally following bariatric surgery in our hospital to evaluate the impact of such surgery on pregnancy, delivery, and neonates. The findings are expected to provide data support for the follow-up and clinical management of such patients. 1. Methods 1.1 Subjects The data of patients who conceived naturally following bariatric surgery between January 2012 and December 2021 were collected from inpatient electronic medical records (at the time of surgery and delivery), outpatient visit records, and follow-up records via phone and WeChat and retrospectively analyzed. The indications for bariatric surgery are as follows: patients with a BMI ≥ 37.5 kg/m2 are recommended for active surgery; patients with a BMI ≥ 32.5 kg/m2 are recommended for surgery; patients with 27.5 kg/m2 ≤ BMI < 32.5 kg/m2 but showing resistance to interventions based on lifestyle changes and medical treatments and having at least 2 complications in the metabolic syndrome groups or obesity-related metabolic complications may consider surgery after comprehensive evaluation. These included patients with central obesity (male waist circumference ≥ 90 cm, female waist circumference ≥ 85 cm). The metabolic syndrome group included patients with hypertriglyceridemia (fasting ≥ 1.70 mmol/L), low-density lipoprotein (LDL) cholesterol (fasting < 1.03 mmol/L in men and < 1.29 mmol/L in women), and hypertension (systolic arterial blood pressure ≥ 130 mmHg or diastolic arterial blood pressure ≥ 85 mmHg). [ 4 – 6 ] This study was reviewed and approved by the Institutional Review Board of * Hospital, *University. 1.2 Surgical methods All surgeries were performed by the same bariatric surgery team. The surgical procedures included laparoscopic sleeve gastrectomy (LSG). Briefly, the fundus and large curvature of the stomach are fully mobilized. A 36 Fr bougie tube was used as the intragastric support tube. Dissection of the greater curvature of the stomach and the fundus begins approximately 6 cm from the pylorus, progressing along the lesser curvature of the stomach toward the left of the cardia. The cardia is preserved intact. The incision margins are closed with continuous reinforced sutures. [ 7 ] The other procedure was laparoscopic Roux-en-Y gastric bypass (LRYGB). Briefly, a gastric pouch of 20 to 30 mL in volume is created below the cardia, bypassing the entire fundus. The alimentary limb is set to a length of 100 cm, and the biliopancreatic limb is also set to a length of 100 cm. The width of the gastrojejunal anastomosis was maintained between 2.0 and 2.5 cm. [ 8 ] 1.3 Observation indicators All patients were followed up at 1, 3, 6, and 12 months postoperatively and annually thereafter, and the pregnancy process was subject to medical observation according to the instructions of obstetrics and gynecology. This study collected the following clinical data from patients: height, preoperative weight, body mass index (BMI), hypertension status, diabetes status, operation mode, weight at 1 year postoperative, percentage of total weight loss (TWL%), percentage of expected weight loss (EWL%), hemoglobin, iron ion, folic acid, vitamin b12, prepregnancy weight, birth weight, gestational weight gain (GWG), postoperative-pregnancy interval, gestational week at birth, gestational blood pressure, eclampsia, blood glucose, acute vomiting, internal hernia, mode of delivery, and concordance with the delivery plane. Neonatal clinical data included birth weight, length, neonatal Apgar score, deformity, and NICU admittance. (Table 1 ) Table 1 Definition of abbreviations and basic concepts Item Connotation Indication EWL% (preoperative weight - postoperative weight)/(preoperative weight - standard weight) × 100% Standard weight as BMI 24 kg/m2 TWL% (preoperative weight - postoperative weight)/preoperative weight × 100% GWG Weight at delivery - weight at 12 weeks of pregnancy (at the time of registration) * 18.5 kg/m2 ≤ BMI < 24 kg/m2 8.0ཞ14.0 kg Greater than the upper limit - excessive weight gain 24.0 kg/m2 ≤ BMI < 28 kg/m2 7.0ཞ11.0 kg Within the range - appropriate weight gain BMI ≥ 28.0 kg/m2 5.0ཞ9.0 kg Less than the lower limit - insufficient weight gain LGA Birth weight above 90th percentile of average weight for gestational age SGA Birth weight below 10th percentile of average weight for gestational age Macrosomia Birth weight > 4000 g EWL: expected weight loss; TWL:total weight loss; GWG: gestational weight gain; LGA: large-for-gestational-age; SGA: small-for-gestational-age; BMI: Body mass index; *The weight gain standard is adopted from the National Health Commission of the People's Republic of China. Recommended weight gain standard for women during pregnancy: WS/T 801–2022. [ 9 ] 1.4 Statistical analysis The quantitative data are expressed as the means ± standard deviations, whereas the qualitative data are presented as numbers and percentages. 2. Results 2.1 Basic Information In this study, 43 women of childbearing age were included, all of whom conceived naturally after bariatric surgery, and 24 provided complete medical records. Among the 24 patients, 1 had 2 separate pregnancies, and 1 had a twin pregnancy. The average age of preoperative patients was 30 years. Five patients underwent RYGB, and 19 underwent LSG. Bariatric surgery resulted in effective weight control, with an average prepregnancy TWL of 26.85% (7.5–43.08%) and an average EWL of 87.9%. Three nonobese patients (with preoperative BMIs of 28 kg/cm2, 26.3 kg/cm2, and 26.1 kg/cm2 and EWLs of 272.68%, 159.66%, and 178.45%, respectively) who underwent surgery for blood glucose control were excluded, and the average EWL of the remaining patients was 72.53% (21.47–146.65%). The minimum postoperative‒pregnancy interval was only 3 months, with 1/3 of the patients conceived within 12 months postoperatively and 2/3 conceived after 12 months. No complications, such as acute vomiting or internal hernia, occurred postoperatively or during pregnancy. Polycystic ovary syndrome (PCOS) was preoperatively diagnosed in 4 patients. Postoperatively, their menstrual cycles normalized, leading to successful pregnancy and delivery. (Table 2 ) Table 2 basic information mean \(\:\pm\:\) standard deviation (n = 24) range preoperative ages(y) 29.84 \(\:\pm\:\) 4.42 24–38 prepregnant ages(y) 32.4 \(\:\pm\:\) 4.00 26–40 preoperative BMI (kg/m2) 38.6 \(\:\pm\:\) 9.18 26.1–63.4 prepregnant BMI (kg/m2) 27.42 \(\:\pm\:\) 5.57 19.95–41.14 postoperative-pregnancy interval (m) 25.68 \(\:\pm\:\) 22.56 3–88 24month 10(41.66%) gestational weight gain (kg) 12.97 ± 7.2 0-27.5 TWL% 26.85%±12.68% 7.5%-43.08% BMI: Body mass index; TWL:total weight loss 2.2 Information on pregnancy and delivery Among the patients, 4 experienced insufficient weight gain during pregnancy (2 underwent LSG, and 2 underwent RYGB), and more than 60% gained excessive weight, leaving only 5 experiencing appropriate weight gain. Preterm births (< 37 weeks) occurred in 2 pregnancies. Among them, 1 patient with a twin pregnancy underwent a cesarean section at 36 + 1 week gestation due to preeclampsia. Another patient conceived 18 months after LSG (with a prepregnancy BMI of 19.9 kg/m2) and underwent a cesarean section at 35 + 5 weeks due to fetal distress. No complications, such as hypertension or diabetes, were diagnosed in this patient before or during pregnancy. Five patients underwent emergency cesarean delivery due to fetal distress (3 patients), prolonged labor (1 patient), and cephalopelvic disproportion (1 patient). Two patients underwent episiotomy during the course of normal labor due to macrosomia and fetal patent foramen ovale (to accelerate the birth process). Anemia developed in 45.83% (11/24) of patients during pregnancy, all of whom had undergone prior LSG. Anemia resolved in all patients following oral supplementation with iron, folic acid, and vitamin B12. (Table 3 ) Table 3 Information on Pregnancy and Delivery insufficient weight gain 4/24 (16.67%) excessive weight gain 15/24 (62.5%) preterm births(<37 weeks) 2/24 (8.33%) full-term birth 22/24 (91.67%) cesarean section 19/24 (79.17%) unplanned 5/19 (26.32%) Conventional labor 5/24 (20.83%) Lateral cut 2/5 (40%) Anemia during pregnancy 11/24 (45.83%) 2.3 Concomitant Illness during Pregnancy After bariatric surgery, 10 patients with obesity and type 2 diabetes were removed from hypoglycemic drugs. Among the 10 patients, 30% (3/10) maintained normal blood glucose during pregnancy, and 70% (7/10) exhibited elevated blood glucose levels again. Among them, 3 required insulin for blood glucose control, and 4 were managed through exercise and diet. Among the 10 patients with comorbid type 2 diabetes, four experienced elevated blood glucose levels after conception following LSG (with 1/2 pregnant within 12 months after surgery, and all 3 pregnancies beyond 12 months after surgery), and 3 experienced elevated blood glucose levels after conception following RYGB (accounting for 75% (3/4) of the pregnancies beyond 24 months after surgery). In addition, 35.71% (5/14) of the patients without preoperative diabetes were diagnosed with gestational diabetes. Among the fetuses born to mothers with elevated blood glucose levels, 4 were LGA, and 1 was SGA. Furthermore, 8 patients with obesity and hypertension before surgery presented normal blood pressure after bariatric surgery and were removed from antihypertensive drugs. During pregnancy, 50% (4/8) of the patients maintained normal blood pressure, and 50% (4/8) experienced elevated blood pressure. The patient’s blood pressure was controlled by oral labetalol, and no eclampsia occurred. Moreover, 37.5% (6/16) of patients without preoperative hypertension were diagnosed with gestational hypertension. (Table 4 ) Table 4 Concomitant Illnesses Preoperative diabetes mellitus 10/24 (41.67%) Relapse during pregnancy 7/10 (70%) gestational diabetes 5/14 (35.71%) Preoperative hypertension 8/24 (33.33%) Relapse during pregnancy 4/8 (50%) gestational hypertension 6/16 (37.5%) 2.4 Neonate conditions All the newborns were delivered successfully and in good health, without NICU admittance or neonatal deaths. The average length at birth was 50.4 cm, and the average weight was 3225.82 g. Only 1 fetus scored an Apgar score of 9 at 1 min after birth, and the score reached 10 at 5 and 10 min. Three fetuses were SGAs, all from mothers with insufficient gestational weight gain, 2 of whom were pregnant more than 24 months after RYGB surgery, and 1 of whom was pregnant 6 months after LSG surgery. Among mothers with appropriate gestational weight gain, 40% (2/5) gave birth to LGA fetuses. Among mothers with excessive weight gain during pregnancy, 50% (7/14) gave birth to LGA fetuses, 1 of which presented with macrosomia. Two of the fetuses had congenital deformities, namely, a deformity of the left accessory ear and a patent foramen ovale. The fetus with a deformity of the left accessory ear was born to a mother with gestational diabetes. (Table 5 ) Table 5 Neonate Data mean \(\:\pm\:\) standard deviation (n = 24) range Length(cm) 50.4 \(\:\pm\:\) 1.85 46–55 Weight(g) 3225.82 \(\:\pm\:\) 471.89 2230–4500 SGA 3/24(12.5%) LGA 9/24(37.5%) macrosomia 1/24(4.17%) apgar-1 min 9.96 \(\:\pm\:\) 0.21 9–10 apgar-5 min 10 \(\:\pm\:\) 0 10–10 apgar-10 min 10 \(\:\pm\:\) 0 10–10 congenital deformity 2/24(8.33%) LGA: large-for-gestational-age; SGA: small-for-gestational-age 3. Discussion LSG and LRYGB are widely accepted bariatric surgeries in China, but long-term complications, especially the safety of postoperative pregnancy, are attracting increasing attention. This study revealed that bariatric surgery had a significant effect on weight control, with an average TWL of 26.85% and an EWL of 72.53%. No cases of weight rebound were observed before pregnancy. Postoperatively, all patients exhibited well-maintained blood pressure and blood glucose levels without requiring medication. These results are consistent with those reported in the literature. [ 10 – 11 ] The efficacy and safety of bariatric surgery for metabolic syndrome and weight control have been fully confirmed. While insufficient gestational weight gain warrants significant attention, this study included only four such cases. Conversely, 62.5% of the patients experienced excessive weight gain during pregnancy, a proportion (> 50%) also reported in another study. [ 12 ] Weight management during pregnancy is crucial for individuals with a history of obesity, necessitating close attention from both patients and healthcare providers. In this study, preterm births occurred in 4.38% of the singleton pregnancies, a proportion significantly lower than that of obese mothers (7%) and slightly lower than that of normal-weight mothers (4.63%), [ 13 ] reported that bariatric surgery did not increase the risk of preterm birth. The 11 patients with anemia during pregnancy were all in the LSG group and were not shown anemia on the basis of trace element monitoring during surgical follow-up. However, the frequency of detection during pregnancy is significantly reduced. These results suggest that the basic supplement dose after bariatric surgery does not meet the needs during pregnancy and that appropriate adjustments are needed according to the test results. Despite the widespread adoption of bariatric surgery within general surgery, its integration into obstetrics and gynecology remains limited. Thus, advocacy and cooperation should be strengthened to ensure the safety of mothers and children. Bariatric surgery is more effective at controlling blood glucose levels than are medications, but it is associated with a lower incidence of related complications. [ 14 ] However, surgery is not always a permanent solution. Approximately 1/3 of the patients with diabetes relapsed after surgery. Patients with earlier surgical interventions and greater weight loss after surgery often face lower risks of blood glucose rebound, and RYGB offers better blood glucose control than LSG does. [ 15 ] This study revealed that bariatric surgery has a significant effect on blood glucose control. Nevertheless, diabetes recurred in 70% of the patients during pregnancy, which is significantly higher than the postoperative rate of 30%. Among patients with preoperative diabetes, 50% experienced recurrence during pregnancy within 1 year after LSG surgery, and this rate increased to 100% in pregnancies more than 1 year after LSG surgery. No patient experienced diabetes recurrence during pregnancy within 2 years after RYGB surgery, and 75% of the patients experienced diabetes recurrence during pregnancy beyond 2 years after surgery. These findings suggest that the long-term efficacy of bariatric surgery in controlling blood glucose may diminish over time. The risk of diabetes recurrence during pregnancy appears to be greater, particularly in patients who have undergone LSG. In this study, 58.3% of the patients with elevated blood glucose during pregnancy had elevated blood pressure, and 41.6% had preeclampsia. Among the neonates, 1 was a premature infant, 1 had a left accessory ear deformity, and 4 had LGAs (44.4% of all LGAs). Studies have shown that patients with elevated blood glucose during pregnancy are three times more likely to develop preeclampsia, gestational hypertension, preterm birth, and LGA than normal controls are and are twice as susceptible to cesarean delivery and congenital malformations. [ 16 ] However, bariatric surgery undeniably prevents diabetes recurrence in 30.0% of patients during pregnancy. A retrospective analysis of 670 patients in Sweden also revealed a lower incidence of gestational diabetes after bariatric surgery. [ 17 ] The results of this study suggest that RYGB is a better and more durable treatment for diabetes. Even though diabetes has completely resolved, patients still have a higher rate of elevated blood glucose during pregnancy. Therefore, blood glucose monitoring should be strengthened during pregnancy to facilitate early detection, timely intervention, and effective prevention of related complications. During pregnancy, 50% of the patients experienced normal blood pressure, and 50% experienced hypertension recurrence, which was resolved through medications. Moreover, no patient developed eclampsia. Bariatric surgery can effectively control blood pressure. A retrospective study covering 30 patients who underwent bariatric surgery and 60 patients with obesity yielded similar findings: the bariatric surgery group presented a lower incidence of hypertension and no eclampsia during pregnancy than did the obese group. [ 18 ] Therefore, bariatric surgery is advantageous for controlling blood pressure even during pregnancy. In this study, 4 patients who were preoperatively diagnosed with PCOS conceived naturally following surgery and delivered smoothly. Patients with PCOS exhibit endocrine and metabolic disorders that often coexist with or induce obesity, thus forming a vicious cycle. A meta-analysis of 14 studies involving 501 patients with PCOS who underwent bariatric surgery reported a postoperative remission rate of 98%. [ 19 ] Another 1-year prospective study compared the effects of LSG with those of medication (oral metformin and contraceptives) and reported that the PCOS remission rate reached 78% in the LSG group (the remission criterion was regular menstruation for 6 consecutive months or natural conception), whereas the remission rate was only 15% in the medication group. [ 20 ] Therefore, bariatric surgery provides new treatment options for PCOS patients with comorbid obesity. By inducing weight loss, it breaks the vicious cycle of obesity and metabolic disorders, thereby effectively improving PCOS symptoms. The 3 (12.5%) SGA fetuses in this study were born to mothers whose gestational weight gain was insufficient. Among them, 1 mother (BMI 26.22 kg/m2 before pregnancy) was pregnant 6 months after LGS surgery and had gestational hypertension. One mother, who had preoperative hypertension and diabetes and experienced recurrence during pregnancy, became pregnant 24 months after RYGB surgery. Another mother (BMI 36.71 kg/m2 before pregnancy) became pregnant 28 months after RYGB surgery, without elevated blood pressure or blood glucose preoperatively or during pregnancy. A cohort study revealed that the main factor influencing neonatal weight during pregnancy is independent of diabetes and maternal weight, but gestational diabetes reinforces this effect. [ 21 ] A two-center retrospective study in France likewise emphasized that proper weight gain helps reduce the occurrence of SAG. [ 22 ] The insufficient weight gain and SGA increase during pregnancy following bariatric surgery can be attributed to two reasons. One is the impact of surgery. The incidence of SGA after RYGB surgery (fluctuations of 12.7–29%) is significantly greater than that after LSG (fluctuations of 8.3–9%). [ 23 – 24 ] However, another retrospective study focusing only on pregnancies following LSG surgery did not find significant differences in neonatal birth weight, gestational age, preterm birth, LGA, or SGA among different weight gain groups. [ 12 ] In our study, 2 of the patients with insufficient weight gain underwent LGS, and the other 2 underwent RYGB. Despite the equal number of cases for each procedure, the total number of RYGB cases was only 5. Therefore, the rate of insufficient gestational weight gain following RYGB surgery reached 40%, while the 10.9% rate following LSG was closer to the results outside China. This bias may be caused by the small number of RYGB surgeries. The second factor is the postoperative‒pregnancy interval. Rapid weight loss and a significant reduction in energy intake within the first 12 months after surgery can lead to peak deficiencies in various nutrients, which in turn affect pregnancy weight gain and fetal growth and development, which is consistent with previous conclusions. [ 14 ] Among the 7 pregnancies within 12 months after surgery (all LSG), the earliest conception was 3 months after surgery. Specifically, 2 patients had insufficient weight gain during pregnancy (1 gave birth to an SGA neonate), 3 had normal weight gain during pregnancy, and 2 had excessive weight gain during pregnancy. Among the pregnancies more than 24 months after surgery, 2 SGA neonates were born to mothers who underwent RYGB. Therefore, RYGB may be more likely to cause insufficient gestational weight gain and SAG. In terms of long-term follow-up, however, a Singapore study of Asian women revealed that although the SGA incidence after bariatric surgery reached 37.5%, the growth and development of these SGA fetuses did not exceed 3% below normal. [ 25 ] Long-term growth and development are unaffected. Another study also revealed no adverse effects of gastric ligation on the mother or fetus. [ 26 ] Bariatric surgery, especially RYGB, may increase the incidence of SGA, and the impact is far-reaching. Our data indicate that even if pregnancy occurs more than 2 years after surgery, the effect of RYGB remains. Therefore, LSG is a better choice for women of childbearing age with childbearing needs. Moreover, a recommended waiting period of at least one year, or until weight stabilization, is advised before attempting pregnancy following bariatric surgery. 4. Summary Bariatric surgery is relatively safe for pregnancy and can effectively reduce the risk of complications such as hypertension and diabetes during pregnancy in patients with obesity. Obesity-related complications such as hypertension and diabetes may relapse during pregnancy, which can cause nutritional problems such as anemia. Therefore, blood pressure, blood glucose, and nutritional status should be closely monitored during pregnancy. RYGB may be more likely to cause insufficient gestational weight gain and SAG and have a long-lasting effect. Therefore, LSG may be a better option for patients with obesity who are planning pregnancy, and pregnancy is advised 12 months after surgery or until weight stabilization. In addition, this was a single-center retrospective study with a limited sample size and a short follow-up period. Thus, larger, multicenter studies are recommended to explore the safety of bariatric surgery for pregnant women and fetuses during pregnancy, delivery, and perinatal periods. Declarations Ethics approval and consent to participate: The study was reviewed and approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University. Consent for publication : Not applicable. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Competing interests : The authors declare that they have no conflicts of interest. Funding: This study was not funded. Authors' contributions : All the authors contributed to the study’s conception and design. Zhong Qi and Xiao-Chen Shi performed the material preparation, data collection, and analysis. Zhong Qi wrote the first draft of the manuscript, and all the authors commented on previous versions. All the authors read and approved the final manuscript. 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Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obes Surg. 2015;25:436–42. 10.1007/s11695-014-1387-7 . Chevrot A, Kayem G, Coupaye M, Lesage N, Msika S, Mandelbrot L. Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol. 2016;214:655. 10.1016/j.ajog.2015.11.017 . Malik S, Teh JL, Lomanto D, Kim G, So JB, Shabbir A. Maternal and fetal outcomes of Asian pregnancies after bariatric surgery. Surg Obes Relat Dis. 2020;16:529–35. 10.1016/j.soard.2020.01.017 . Pilone V, Hasani A, Di Micco R, Vitiello A, Monda A, Izzo G, et al. Pregnancy after laparoscopic gastric banding: maternal and neonatal outcomes. Int J Surg. 2014;12(Suppl 1):S136–139. 10.1016/j.ijsu.2014.05.027 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6850277","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482423195,"identity":"6918b35c-cab3-441e-a473-895db852835e","order_by":0,"name":"Zhong Qi","email":"","orcid":"","institution":"Beijing TianTan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhong","middleName":"","lastName":"Qi","suffix":""},{"id":482423197,"identity":"2b653f3d-91f2-4372-ad70-eca1dc32d595","order_by":1,"name":"Xiao-Chen Shi","email":"","orcid":"","institution":"Beijing TianTan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiao-Chen","middleName":"","lastName":"Shi","suffix":""},{"id":482423199,"identity":"0d38fb92-60f5-4846-a975-58df4240295f","order_by":2,"name":"Ri-Xing Bai","email":"","orcid":"","institution":"Beijing TianTan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ri-Xing","middleName":"","lastName":"Bai","suffix":""},{"id":482423201,"identity":"f4458357-ab6d-4e6f-801d-7cfc55f35c47","order_by":3,"name":"Wen-Mao Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYPACGx42ZuYDBz78IF5Lmhw/e1viwZk9xGs5bCzZc8b4MAcbEWoNbmQnfvjAwJy44UbOh8MMPAzy/GIHCGnJ3Sw5g4ENqCV3w+ECCwbDmbMTCGi5nbtBmoeBB6JlBg9DgsFtwlo2/+ZhkAA57MFhHjbitGwD2mIA8j4DcVok77/dZjmDIQEUyAbAQJYg7Be+M2c33/jA8B8UlY8/fPhhI88vTUCLwgEgwfgPzpfArxwE5BsIqxkFo2AUjIKRDgAjcknWqE6xYgAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing TianTan Hospital","correspondingAuthor":true,"prefix":"","firstName":"Wen-Mao","middleName":"","lastName":"Yan","suffix":""}],"badges":[],"createdAt":"2025-06-09 03:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6850277/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6850277/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104780753,"identity":"e59999b8-0662-40da-8b25-cfa20a64d0d4","added_by":"auto","created_at":"2026-03-17 07:53:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":555169,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6850277/v1/fe988945-03f9-439b-8cda-3a34219d51c0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retrospective Analysis of Pregnancy Following Bariatric Surgery","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eObesity has reached epidemic proportions globally, with over 50% of adults in China now classified as overweight or obese. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Obesity is often comorbid with diseases such as type 2 diabetes, hypertension, and dyslipidemia, which pose multiple levels of threats to patients, and has become the sixth cause of death from chronic noncommunicable diseases in China. \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Obesity is a risk factor for various conditions, including infertility, gestational diabetes, and gestational hypertension. Moreover, it increases the incidence of macrosomia, cesarean section, miscarriage, premature birth, etc., which seriously affects maternal and fetal health. Weight loss can effectively reduce the incidence of the above diseases but may increase the incidence of smaller for gestational age (SGA) infants. Bariatric surgery has emerged as an effective intervention for obesity and its complications and can effectively regulate weight, blood sugar, and blood pressure. In China, 70% of bariatric surgery patients are women, with a median age of 32 years,\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e making it a demographic comprising mostly women of childbearing age. Considering the limited clinical data on pregnancy after bariatric surgery in China, a retrospective analysis was conducted on the clinical and pregnancy data of patients who conceived naturally following bariatric surgery in our hospital to evaluate the impact of such surgery on pregnancy, delivery, and neonates. The findings are expected to provide data support for the follow-up and clinical management of such patients.\u003c/p\u003e"},{"header":"1. Methods","content":"\u003cp\u003e1.1 Subjects\u003c/p\u003e\u003cp\u003eThe data of patients who conceived naturally following bariatric surgery between January 2012 and December 2021 were collected from inpatient electronic medical records (at the time of surgery and delivery), outpatient visit records, and follow-up records via phone and WeChat and retrospectively analyzed. The indications for bariatric surgery are as follows: patients with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;37.5 kg/m2 are recommended for active surgery; patients with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;32.5 kg/m2 are recommended for surgery; patients with 27.5 kg/m2\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;32.5 kg/m2 but showing resistance to interventions based on lifestyle changes and medical treatments and having at least 2 complications in the metabolic syndrome groups or obesity-related metabolic complications may consider surgery after comprehensive evaluation. These included patients with central obesity (male waist circumference\u0026thinsp;\u0026ge;\u0026thinsp;90 cm, female waist circumference\u0026thinsp;\u0026ge;\u0026thinsp;85 cm). The metabolic syndrome group included patients with hypertriglyceridemia (fasting\u0026thinsp;\u0026ge;\u0026thinsp;1.70 mmol/L), low-density lipoprotein (LDL) cholesterol (fasting\u0026thinsp;\u0026lt;\u0026thinsp;1.03 mmol/L in men and \u0026lt;\u0026thinsp;1.29 mmol/L in women), and hypertension (systolic arterial blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;130 mmHg or diastolic arterial blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;85 mmHg). \u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e This study was reviewed and approved by the Institutional Review Board of * Hospital, *University.\u003c/p\u003e\u003cp\u003e1.2 Surgical methods\u003c/p\u003e\u003cp\u003eAll surgeries were performed by the same bariatric surgery team. The surgical procedures included laparoscopic sleeve gastrectomy (LSG). Briefly, the fundus and large curvature of the stomach are fully mobilized. A 36 Fr bougie tube was used as the intragastric support tube. Dissection of the greater curvature of the stomach and the fundus begins approximately 6 cm from the pylorus, progressing along the lesser curvature of the stomach toward the left of the cardia. The cardia is preserved intact. The incision margins are closed with continuous reinforced sutures. \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e The other procedure was laparoscopic Roux-en-Y gastric bypass (LRYGB). Briefly, a gastric pouch of 20 to 30 mL in volume is created below the cardia, bypassing the entire fundus. The alimentary limb is set to a length of 100 cm, and the biliopancreatic limb is also set to a length of 100 cm. The width of the gastrojejunal anastomosis was maintained between 2.0 and 2.5 cm. \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e1.3 Observation indicators\u003c/p\u003e\u003cp\u003eAll patients were followed up at 1, 3, 6, and 12 months postoperatively and annually thereafter, and the pregnancy process was subject to medical observation according to the instructions of obstetrics and gynecology.\u003c/p\u003e\u003cp\u003eThis study collected the following clinical data from patients: height, preoperative weight, body mass index (BMI), hypertension status, diabetes status, operation mode, weight at 1 year postoperative, percentage of total weight loss (TWL%), percentage of expected weight loss (EWL%), hemoglobin, iron ion, folic acid, vitamin b12, prepregnancy weight, birth weight, gestational weight gain (GWG), postoperative-pregnancy interval, gestational week at birth, gestational blood pressure, eclampsia, blood glucose, acute vomiting, internal hernia, mode of delivery, and concordance with the delivery plane.\u003c/p\u003e\u003cp\u003eNeonatal clinical data included birth weight, length, neonatal Apgar score, deformity, and NICU admittance. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDefinition of abbreviations and basic concepts\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConnotation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIndication\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEWL%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(preoperative weight - postoperative weight)/(preoperative weight - standard weight) \u0026times; 100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard weight as BMI 24 kg/m2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTWL%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(preoperative weight - postoperative weight)/preoperative weight \u0026times; 100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGWG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeight at delivery - weight at 12 weeks of pregnancy (at the time of registration) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.5 kg/m2\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;24 kg/m2 8.0ཞ14.0 kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGreater than the upper limit - excessive weight gain\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.0 kg/m2\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;28 kg/m2 7.0ཞ11.0 kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWithin the range - appropriate weight gain\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBMI\u0026thinsp;\u0026ge;\u0026thinsp;28.0 kg/m2 5.0ཞ9.0 kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLess than the lower limit - insufficient weight gain\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLGA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBirth weight above 90th percentile of average weight for gestational age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSGA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBirth weight below 10th percentile of average weight for gestational age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacrosomia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBirth weight\u0026thinsp;\u0026gt;\u0026thinsp;4000 g\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eEWL: expected weight loss; TWL:total weight loss; GWG: gestational weight gain; LGA: large-for-gestational-age; SGA: small-for-gestational-age; BMI: Body mass index; *The weight gain standard is adopted from the National Health Commission of the People's Republic of China. Recommended weight gain standard for women during pregnancy: WS/T 801\u0026ndash;2022. \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e1.4 Statistical analysis\u003c/p\u003e\u003cp\u003eThe quantitative data are expressed as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, whereas the qualitative data are presented as numbers and percentages.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cp\u003e2.1 Basic Information\u003c/p\u003e\u003cp\u003eIn this study, 43 women of childbearing age were included, all of whom conceived naturally after bariatric surgery, and 24 provided complete medical records. Among the 24 patients, 1 had 2 separate pregnancies, and 1 had a twin pregnancy. The average age of preoperative patients was 30 years. Five patients underwent RYGB, and 19 underwent LSG. Bariatric surgery resulted in effective weight control, with an average prepregnancy TWL of 26.85% (7.5\u0026ndash;43.08%) and an average EWL of 87.9%. Three nonobese patients (with preoperative BMIs of 28 kg/cm2, 26.3 kg/cm2, and 26.1 kg/cm2 and EWLs of 272.68%, 159.66%, and 178.45%, respectively) who underwent surgery for blood glucose control were excluded, and the average EWL of the remaining patients was 72.53% (21.47\u0026ndash;146.65%). The minimum postoperative‒pregnancy interval was only 3 months, with 1/3 of the patients conceived within 12 months postoperatively and 2/3 conceived after 12 months. No complications, such as acute vomiting or internal hernia, occurred postoperatively or during pregnancy. Polycystic ovary syndrome (PCOS) was preoperatively diagnosed in 4 patients. Postoperatively, their menstrual cycles normalized, leading to successful pregnancy and delivery. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ebasic information\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003emean\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003estandard deviation\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003erange\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epreoperative ages(y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.84\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e4.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u0026ndash;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eprepregnant ages(y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.4\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epreoperative BMI (kg/m2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.6\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e9.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.1\u0026ndash;63.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eprepregnant BMI (kg/m2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.42\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e5.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.95\u0026ndash;41.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epostoperative-pregnancy interval (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.68\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e22.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u0026ndash;88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;12month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(29.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12-24month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(29.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;24month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(41.66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egestational weight gain (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.97\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0-27.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTWL%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.85%\u0026plusmn;12.68%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5%-43.08%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eBMI: Body mass index; TWL:total weight loss\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e2.2 Information on pregnancy and delivery\u003c/p\u003e\u003cp\u003eAmong the patients, 4 experienced insufficient weight gain during pregnancy (2 underwent LSG, and 2 underwent RYGB), and more than 60% gained excessive weight, leaving only 5 experiencing appropriate weight gain. Preterm births (\u0026lt;\u0026thinsp;37 weeks) occurred in 2 pregnancies. Among them, 1 patient with a twin pregnancy underwent a cesarean section at 36\u0026thinsp;+\u0026thinsp;1 week gestation due to preeclampsia. Another patient conceived 18 months after LSG (with a prepregnancy BMI of 19.9 kg/m2) and underwent a cesarean section at 35\u0026thinsp;+\u0026thinsp;5 weeks due to fetal distress. No complications, such as hypertension or diabetes, were diagnosed in this patient before or during pregnancy. Five patients underwent emergency cesarean delivery due to fetal distress (3 patients), prolonged labor (1 patient), and cephalopelvic disproportion (1 patient). Two patients underwent episiotomy during the course of normal labor due to macrosomia and fetal patent foramen ovale (to accelerate the birth process). Anemia developed in 45.83% (11/24) of patients during pregnancy, all of whom had undergone prior LSG. Anemia resolved in all patients following oral supplementation with iron, folic acid, and vitamin B12. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInformation on Pregnancy and Delivery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003einsufficient weight gain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4/24 (16.67%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eexcessive weight gain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15/24 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epreterm births(\u0026lt;37 weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2/24 (8.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efull-term birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22/24 (91.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19/24 (79.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunplanned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5/19 (26.32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConventional labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5/24 (20.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLateral cut\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2/5 (40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnemia during pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11/24 (45.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e2.3 Concomitant Illness during Pregnancy\u003c/p\u003e\u003cp\u003eAfter bariatric surgery, 10 patients with obesity and type 2 diabetes were removed from hypoglycemic drugs. Among the 10 patients, 30% (3/10) maintained normal blood glucose during pregnancy, and 70% (7/10) exhibited elevated blood glucose levels again. Among them, 3 required insulin for blood glucose control, and 4 were managed through exercise and diet. Among the 10 patients with comorbid type 2 diabetes, four experienced elevated blood glucose levels after conception following LSG (with 1/2 pregnant within 12 months after surgery, and all 3 pregnancies beyond 12 months after surgery), and 3 experienced elevated blood glucose levels after conception following RYGB (accounting for 75% (3/4) of the pregnancies beyond 24 months after surgery). In addition, 35.71% (5/14) of the patients without preoperative diabetes were diagnosed with gestational diabetes. Among the fetuses born to mothers with elevated blood glucose levels, 4 were LGA, and 1 was SGA.\u003c/p\u003e\u003cp\u003eFurthermore, 8 patients with obesity and hypertension before surgery presented normal blood pressure after bariatric surgery and were removed from antihypertensive drugs. During pregnancy, 50% (4/8) of the patients maintained normal blood pressure, and 50% (4/8) experienced elevated blood pressure. The patient\u0026rsquo;s blood pressure was controlled by oral labetalol, and no eclampsia occurred. Moreover, 37.5% (6/16) of patients without preoperative hypertension were diagnosed with gestational hypertension. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eConcomitant Illnesses\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative diabetes mellitus\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10/24 (41.67%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelapse during pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7/10 (70%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egestational diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5/14 (35.71%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8/24 (33.33%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelapse during pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4/8 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egestational hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6/16 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e2.4 Neonate conditions\u003c/p\u003e\u003cp\u003eAll the newborns were delivered successfully and in good health, without NICU admittance or neonatal deaths. The average length at birth was 50.4 cm, and the average weight was 3225.82 g. Only 1 fetus scored an Apgar score of 9 at 1 min after birth, and the score reached 10 at 5 and 10 min. Three fetuses were SGAs, all from mothers with insufficient gestational weight gain, 2 of whom were pregnant more than 24 months after RYGB surgery, and 1 of whom was pregnant 6 months after LSG surgery. Among mothers with appropriate gestational weight gain, 40% (2/5) gave birth to LGA fetuses. Among mothers with excessive weight gain during pregnancy, 50% (7/14) gave birth to LGA fetuses, 1 of which presented with macrosomia. Two of the fetuses had congenital deformities, namely, a deformity of the left accessory ear and a patent foramen ovale. The fetus with a deformity of the left accessory ear was born to a mother with gestational diabetes. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNeonate Data\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003emean\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003estandard deviation\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003erange\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.4\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight(g)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3225.82\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e471.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2230\u0026ndash;4500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSGA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3/24(12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLGA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9/24(37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emacrosomia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1/24(4.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eapgar-1 min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.96\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eapgar-5 min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eapgar-10 min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003econgenital deformity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2/24(8.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eLGA: large-for-gestational-age; SGA: small-for-gestational-age\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eLSG and LRYGB are widely accepted bariatric surgeries in China, but long-term complications, especially the safety of postoperative pregnancy, are attracting increasing attention. This study revealed that bariatric surgery had a significant effect on weight control, with an average TWL of 26.85% and an EWL of 72.53%. No cases of weight rebound were observed before pregnancy. Postoperatively, all patients exhibited well-maintained blood pressure and blood glucose levels without requiring medication. These results are consistent with those reported in the literature. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e The efficacy and safety of bariatric surgery for metabolic syndrome and weight control have been fully confirmed.\u003c/p\u003e\u003cp\u003eWhile insufficient gestational weight gain warrants significant attention, this study included only four such cases. Conversely, 62.5% of the patients experienced excessive weight gain during pregnancy, a proportion (\u0026gt;\u0026thinsp;50%) also reported in another study. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e Weight management during pregnancy is crucial for individuals with a history of obesity, necessitating close attention from both patients and healthcare providers. In this study, preterm births occurred in 4.38% of the singleton pregnancies, a proportion significantly lower than that of obese mothers (7%) and slightly lower than that of normal-weight mothers (4.63%), \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e reported that bariatric surgery did not increase the risk of preterm birth.\u003c/p\u003e\u003cp\u003eThe 11 patients with anemia during pregnancy were all in the LSG group and were not shown anemia on the basis of trace element monitoring during surgical follow-up. However, the frequency of detection during pregnancy is significantly reduced. These results suggest that the basic supplement dose after bariatric surgery does not meet the needs during pregnancy and that appropriate adjustments are needed according to the test results. Despite the widespread adoption of bariatric surgery within general surgery, its integration into obstetrics and gynecology remains limited. Thus, advocacy and cooperation should be strengthened to ensure the safety of mothers and children.\u003c/p\u003e\u003cp\u003eBariatric surgery is more effective at controlling blood glucose levels than are medications, but it is associated with a lower incidence of related complications. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e However, surgery is not always a permanent solution. Approximately 1/3 of the patients with diabetes relapsed after surgery. Patients with earlier surgical interventions and greater weight loss after surgery often face lower risks of blood glucose rebound, and RYGB offers better blood glucose control than LSG does. \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e This study revealed that bariatric surgery has a significant effect on blood glucose control. Nevertheless, diabetes recurred in 70% of the patients during pregnancy, which is significantly higher than the postoperative rate of 30%. Among patients with preoperative diabetes, 50% experienced recurrence during pregnancy within 1 year after LSG surgery, and this rate increased to 100% in pregnancies more than 1 year after LSG surgery. No patient experienced diabetes recurrence during pregnancy within 2 years after RYGB surgery, and 75% of the patients experienced diabetes recurrence during pregnancy beyond 2 years after surgery. These findings suggest that the long-term efficacy of bariatric surgery in controlling blood glucose may diminish over time. The risk of diabetes recurrence during pregnancy appears to be greater, particularly in patients who have undergone LSG.\u003c/p\u003e\u003cp\u003eIn this study, 58.3% of the patients with elevated blood glucose during pregnancy had elevated blood pressure, and 41.6% had preeclampsia. Among the neonates, 1 was a premature infant, 1 had a left accessory ear deformity, and 4 had LGAs (44.4% of all LGAs). Studies have shown that patients with elevated blood glucose during pregnancy are three times more likely to develop preeclampsia, gestational hypertension, preterm birth, and LGA than normal controls are and are twice as susceptible to cesarean delivery and congenital malformations. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e However, bariatric surgery undeniably prevents diabetes recurrence in 30.0% of patients during pregnancy. A retrospective analysis of 670 patients in Sweden also revealed a lower incidence of gestational diabetes after bariatric surgery. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e The results of this study suggest that RYGB is a better and more durable treatment for diabetes. Even though diabetes has completely resolved, patients still have a higher rate of elevated blood glucose during pregnancy. Therefore, blood glucose monitoring should be strengthened during pregnancy to facilitate early detection, timely intervention, and effective prevention of related complications.\u003c/p\u003e\u003cp\u003eDuring pregnancy, 50% of the patients experienced normal blood pressure, and 50% experienced hypertension recurrence, which was resolved through medications. Moreover, no patient developed eclampsia. Bariatric surgery can effectively control blood pressure. A retrospective study covering 30 patients who underwent bariatric surgery and 60 patients with obesity yielded similar findings: the bariatric surgery group presented a lower incidence of hypertension and no eclampsia during pregnancy than did the obese group. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e Therefore, bariatric surgery is advantageous for controlling blood pressure even during pregnancy.\u003c/p\u003e\u003cp\u003eIn this study, 4 patients who were preoperatively diagnosed with PCOS conceived naturally following surgery and delivered smoothly. Patients with PCOS exhibit endocrine and metabolic disorders that often coexist with or induce obesity, thus forming a vicious cycle. A meta-analysis of 14 studies involving 501 patients with PCOS who underwent bariatric surgery reported a postoperative remission rate of 98%. \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e Another 1-year prospective study compared the effects of LSG with those of medication (oral metformin and contraceptives) and reported that the PCOS remission rate reached 78% in the LSG group (the remission criterion was regular menstruation for 6 consecutive months or natural conception), whereas the remission rate was only 15% in the medication group. \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e Therefore, bariatric surgery provides new treatment options for PCOS patients with comorbid obesity. By inducing weight loss, it breaks the vicious cycle of obesity and metabolic disorders, thereby effectively improving PCOS symptoms.\u003c/p\u003e\u003cp\u003eThe 3 (12.5%) SGA fetuses in this study were born to mothers whose gestational weight gain was insufficient. Among them, 1 mother (BMI 26.22 kg/m2 before pregnancy) was pregnant 6 months after LGS surgery and had gestational hypertension. One mother, who had preoperative hypertension and diabetes and experienced recurrence during pregnancy, became pregnant 24 months after RYGB surgery. Another mother (BMI 36.71 kg/m2 before pregnancy) became pregnant 28 months after RYGB surgery, without elevated blood pressure or blood glucose preoperatively or during pregnancy. A cohort study revealed that the main factor influencing neonatal weight during pregnancy is independent of diabetes and maternal weight, but gestational diabetes reinforces this effect. \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e A two-center retrospective study in France likewise emphasized that proper weight gain helps reduce the occurrence of SAG. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe insufficient weight gain and SGA increase during pregnancy following bariatric surgery can be attributed to two reasons. One is the impact of surgery. The incidence of SGA after RYGB surgery (fluctuations of 12.7\u0026ndash;29%) is significantly greater than that after LSG (fluctuations of 8.3\u0026ndash;9%). \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e However, another retrospective study focusing only on pregnancies following LSG surgery did not find significant differences in neonatal birth weight, gestational age, preterm birth, LGA, or SGA among different weight gain groups. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e In our study, 2 of the patients with insufficient weight gain underwent LGS, and the other 2 underwent RYGB. Despite the equal number of cases for each procedure, the total number of RYGB cases was only 5. Therefore, the rate of insufficient gestational weight gain following RYGB surgery reached 40%, while the 10.9% rate following LSG was closer to the results outside China. This bias may be caused by the small number of RYGB surgeries.\u003c/p\u003e\u003cp\u003eThe second factor is the postoperative‒pregnancy interval. Rapid weight loss and a significant reduction in energy intake within the first 12 months after surgery can lead to peak deficiencies in various nutrients, which in turn affect pregnancy weight gain and fetal growth and development, which is consistent with previous conclusions. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Among the 7 pregnancies within 12 months after surgery (all LSG), the earliest conception was 3 months after surgery. Specifically, 2 patients had insufficient weight gain during pregnancy (1 gave birth to an SGA neonate), 3 had normal weight gain during pregnancy, and 2 had excessive weight gain during pregnancy. Among the pregnancies more than 24 months after surgery, 2 SGA neonates were born to mothers who underwent RYGB. Therefore, RYGB may be more likely to cause insufficient gestational weight gain and SAG.\u003c/p\u003e\u003cp\u003eIn terms of long-term follow-up, however, a Singapore study of Asian women revealed that although the SGA incidence after bariatric surgery reached 37.5%, the growth and development of these SGA fetuses did not exceed 3% below normal. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e Long-term growth and development are unaffected. Another study also revealed no adverse effects of gastric ligation on the mother or fetus. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e Bariatric surgery, especially RYGB, may increase the incidence of SGA, and the impact is far-reaching. Our data indicate that even if pregnancy occurs more than 2 years after surgery, the effect of RYGB remains. Therefore, LSG is a better choice for women of childbearing age with childbearing needs. Moreover, a recommended waiting period of at least one year, or until weight stabilization, is advised before attempting pregnancy following bariatric surgery.\u003c/p\u003e"},{"header":"4. Summary","content":"\u003cp\u003eBariatric surgery is relatively safe for pregnancy and can effectively reduce the risk of complications such as hypertension and diabetes during pregnancy in patients with obesity. Obesity-related complications such as hypertension and diabetes may relapse during pregnancy, which can cause nutritional problems such as anemia. Therefore, blood pressure, blood glucose, and nutritional status should be closely monitored during pregnancy. RYGB may be more likely to cause insufficient gestational weight gain and SAG and have a long-lasting effect. Therefore, LSG may be a better option for patients with obesity who are planning pregnancy, and pregnancy is advised 12 months after surgery or until weight stabilization. In addition, this was a single-center retrospective study with a limited sample size and a short follow-up period. Thus, larger, multicenter studies are recommended to explore the safety of bariatric surgery for pregnant women and fetuses during pregnancy, delivery, and perinatal periods.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was reviewed and approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003epublication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e All data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einterests\u003c/strong\u003e: The authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e: All the authors contributed to the study’s conception and design. Zhong Qi and Xiao-Chen Shi performed the material preparation, data collection, and analysis. Zhong Qi wrote the first draft of the manuscript, and all the authors commented on previous versions. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eReport on Nutrition and Chronic Diseases of Chinese Residents. (2020) (in Chinese) [J]. ACTA Nutrimental SINICA, 2020, 42 (06): 521.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. 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Int J Surg. 2014;12(Suppl 1):S136\u0026ndash;139. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijsu.2014.05.027\u003c/span\u003e\u003cspan address=\"10.1016/j.ijsu.2014.05.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bariatric surgery, pregnancy, diabetes mellitus, hypertension, neonatal, complications","lastPublishedDoi":"10.21203/rs.3.rs-6850277/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6850277/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eObesity increases the risk of infertility, gestational diabetes, and hypertension. While weight loss reduces these risks, it may increase the incidence of small-for-gestational-age (SGA) infants. To investigate the effects and safety of pregnant women and neonates during pregnancy and delivery after bariatric surgery.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA retrospective analysis was conducted on 43 women who conceived naturally after bariatric surgery at ** hospital between January 2012 and December 2021, with 24 providing complete data. The parameters included patient body mass index, postoperative pregnancy interval, maternal blood pressure and glucose levels, maternal nutritional status throughout pregnancy, mode of delivery, and neonatal outcomes such as birth weight, length, Apgar score, presence of deformities, mortality, and the need for NICU monitoring.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFive patients underwent Roux-en-Y gastric bypass (RYGB), and 19 underwent laparoscopic sleeve gastrectomy (LSG). The average prepregnancy total weight loss (TWL) was 26.85%. During pregnancy, 45.83% of the patients developed anemia, and 16.67% of the patients experienced insufficient weight gain during pregnancy. Preoperatively, 10 of the patients had comorbid type 2 diabetes, and 8 had comorbid hypertension, which was controlled postoperatively. However, diabetes recurred in 70% of the patients during pregnancy, with the recurrence rate in the LSG group being higher than that in the RYGB group, and hypertension recurred in 50% of the patients. No neonatal deaths or NICU admissions were observed. The rate of preterm birth was 4.35%, which is below average. The incidence of smaller-for-gestational-age infants was 12.5%, occurring exclusively in pregnancies with insufficient gestational weight gain, especially after RYGB.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePregnancy after bariatric surgery is relatively safe, reducing obesity-related complications. However, LSG may be preferable for patients with obesity who are planning pregnancy, and a waiting period is advised until their weight stabilizes. Indicators such as weight, blood pressure, blood sugar, and nutritional status should be closely monitored during pregnancy.\u003c/p\u003e","manuscriptTitle":"Retrospective Analysis of Pregnancy Following Bariatric Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-11 15:35:10","doi":"10.21203/rs.3.rs-6850277/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c4ceaac2-f81d-4725-babf-955fd96b62a6","owner":[],"postedDate":"July 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T20:24:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-11 15:35:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6850277","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6850277","identity":"rs-6850277","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}