A Matter of Timing—Pregnancy After Bariatric Surgery

Abstract Purpose Current guidelines recommend to avoid pregnancy for 12–24 months after bariatric surgery because of active weight loss and an increased risk of nutritional deficiencies. However, high-quality evidence is lacking, and only a few studies included data on gestational weight gain. We therefore evaluated pregnancy and neonatal outcomes by both surgery-to-conception interval and gestational weight gain. Materials and Methods A multicenter retrospective analysis of 196 singleton pregnancies following Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was conducted. Pregnancies were divided into the early group (≤ 12 months), the middle group (12–24 months), and the late group (> 24 months) according to the surgery-to-conception interval. Gestational weight gain was classified as inadequate, adequate, or excessive according to the National Academy of Medicine recommendations. Results Pregnancy in the early group (23.5%) was associated with lower gestational age at delivery (267.1 ± 19.9 days vs 272.7 ± 9.2 and 273.1 ± 13.5 days, P = 0.029), lower gestational weight gain (− 0.9 ± 11.0 kg vs + 10.2 ± 5.6 and + 10.0 ± 6.4 kg, P < 0.001), and lower neonatal birth weight (2979 ± 470 g vs 3161 ± 481 and 3211 ± 465 g, P = 0.008) than pregnancy in the middle and late group. Inadequate gestational weight gain (40.6%) was associated with lower gestational age at delivery (266.5 ± 20.2 days vs 273.8 ± 8.4 days, P = 0.002) and lower neonatal birth weight (3061 ± 511 g vs 3217 ± 479 g, P = 0.053) compared to adequate weight gain. Preterm births were also more frequently observed in this group (15.9% vs 6.0%, P = 0.037). Conclusion Our findings support the recommendation to avoid pregnancy for 12 months after bariatric surgery. Specific attention is needed on achieving adequate gestational weight gain.

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Association among pre-pregnancy body mass index, gestational weight gain and neonatal birth weight: a prospective cohort study in China

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03323-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yawen Wang ◽

Haihui Ma ◽

Yahui Feng ◽

Yongle Zhan ◽

Sansan Wu ◽

...

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Birth Weight ◽

Gestational Weight Gain ◽

Body Mass ◽

Gestational Age ◽

Chinese Women ◽

Response Analysis ◽

Gestational Weight ◽

Neonatal Birth Weight

Abstract Background This study aims to explore the relationships between pre-pregnancy body mass index (BMI), gestational weight gain (GWG), rate of GWG during the second and third trimesters (GWGrate) and birth weight among Chinese women. Methods Women were enrolled by 24 hospitals in 15 different provinces in mainland China from July 25th, 2017 to 26 November 2018. Pre-pregnancy BMI, GWG and GWGrate were calculated and divided in to different groups. The multinomial logistic regression model and restrictive cubic spline model were used to explore the relationships. Results Of the 3585 participants, women who were underweight, had insufficient GWG or GWGrate had 1.853-, 1850- or 1.524-fold higher risks for delivering small-for-gestational-age (SGA) infant compared with women who had normal BMI, sufficient GWG or GWGrate. Women who were overweight/obese, had excessive GWG or GWGrate had 1.996-, 1676- or 1.673-fold higher risks for delivering large-for-gestational-age (LGA) infant. The effects of GWG and GWGrate on birth weight varied by pre-pregnancy BMI statuses. Dose-response analysis demonstrated L-shaped and S-shaped relationships between pre-pregnancy BMI, GWG, GWGrate and neonatal birth weight. Conclusions Pre-pregnancy BMI, GWG or GWGrate were associated with neonatal birth weight among Chinese women. Both body weight before and during pregnancy should be maintained within the recommendations to prevent abnormal birth weight.

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Leptin and Ghrelin in Excessive Gestational Weight Gain—Association between Mothers and Offspring

International Journal of Molecular Sciences ◽

10.3390/ijms20102398 ◽

2019 ◽

Vol 20 (10) ◽

pp. 2398 ◽

Cited By ~ 3

Author(s):

Jolanta Patro-Małysza ◽

Marcin Trojnar ◽

Katarzyna E. Skórzyńska-Dziduszko ◽

Żaneta Kimber-Trojnar ◽

Dorota Darmochwał-Kolarz ◽

...

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Weight Gain ◽

Body Length ◽

Head Circumference ◽

Maternal Serum ◽

Control Group ◽

Gestational Weight ◽

Neonatal Birth Weight ◽

Serum Ghrelin

Two-thirds of pregnant women exceed gestational weight gain recommendations. Excessive gestational weight gain (EGWG) appears to be associated with offspring’s complications induced by mechanisms that are still unclear. The aim of this study was to investigate whether umbilical cord leptin (UCL) and ghrelin (UCG) concentrations are altered in full-term neonates born to EGWG mothers and whether neonatal anthropometric measurements correlate with UCL and UCG levels and maternal serum ghrelin and leptin as well as urine ghrelin concentrations. The study subjects were divided into two groups, 28 healthy controls and 38 patients with EGWG. Lower UCL and UCG levels were observed in neonates born to healthy mothers but only in male newborns. In the control group UCG concentrations correlated positively with neonatal birth weight, body length and head circumference. In the control group maternal serum ghrelin levels correlated negatively with neonatal birth weight, body length and head circumference as well as positively with chest circumference. In the EGWG group UCG concentrations correlated negatively with neonatal birth weight and birth body length. UCL correlated positively with birth body length in EGWG group and negatively with head circumference in the control group. In conclusion, EGWG is associated with disturbances in UCL and UCG concentrations.

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Gestational weight gain and postpartum weight retention after bariatric surgery: data from a prospective cohort study

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2020.12.009 ◽

2020 ◽

Author(s):

Dries Ceulemans ◽

Paulien De Mulder ◽

Barbara Lebbe ◽

Marc Coppens ◽

Ben De Becker ◽

...

Keyword(s):

Bariatric Surgery ◽

Cohort Study ◽

Weight Gain ◽

Gestational Weight Gain ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postpartum Weight Retention ◽

Weight Retention ◽

Gestational Weight ◽

Postpartum Weight

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Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age

Can J Public Health ◽

10.17269/s41997-018-0086-x ◽

2018 ◽

Vol 109 (4) ◽

pp. 527-538 ◽

Cited By ~ 11

Author(s):

Sarah D. McDonald ◽

Christy Woolcott ◽

Núria Chapinal ◽

Yanfang Guo ◽

Phil Murphy ◽

...

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Birth Weight ◽

Gestational Weight Gain ◽

Body Mass ◽

Gestational Age ◽

Large For Gestational Age ◽

Gestational Weight ◽

Neonatal Birth Weight

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Maternal urinary concentrations of organophosphate ester metabolites: associations with gestational weight gain, early life anthropometry, and infant eating behaviors among mothers-infant pairs in Rhode Island

Environmental Health ◽

10.1186/s12940-020-00648-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Kathryn A. Crawford ◽

Nicola Hawley ◽

Antonia M. Calafat ◽

Nayana K. Jayatilaka ◽

Rosemary J. Froehlich ◽

...

Keyword(s):

Weight Gain ◽

Feeding Behavior ◽

Infant Feeding ◽

Rhode Island ◽

Gestational Weight Gain ◽

Gestational Age ◽

Skinfold Thickness ◽

Abdominal Circumference ◽

Gestational Weight ◽

Gestational Age At Delivery

Abstract Background Organophosphate esters (OPEs)—used as flame retardants and plasticizers—are associated with adverse pregnancy outcomes such as reduced fecundity and live births and increased preterm delivery. OPEs may interfere with growth and metabolism via endocrine-disruption, but few studies have investigated endocrine-related outcomes. The objective of this pilot study (n = 56 mother-infant pairs) was to evaluate associations of OPEs with gestational weight gain (GWG), gestational age at delivery, infant anthropometry, and infant feeding behaviors. Methods We quantified OPE metabolites (bis-2-chloroethyl phosphate [BCEP], bis (1,3-dichloro-2-propyl) phosphate [BDCPP], diphenyl phosphate [DPHP]) in pooled maternal spot urine collected throughout pregnancy (~ 12, 28, and 35 weeks’ gestation). We obtained maternal sociodemographic characteristics from questionnaires administered at enrollment and perinatal characteristics from medical record abstraction. Trained research assistants measured infant weight, length, head and abdominal circumferences, and skinfold thicknesses at birth and 6 weeks postpartum. Mothers reported infant feeding behavior via the Baby Eating Behavior Questionnaire (BEBQ). Using multiple linear regression, we assessed associations of log2-transformed maternal urinary OPE metabolites with GWG, gestational age at delivery, infant anthropometry at birth, weekly growth rate, and BEBQ scores at 6 weeks postpartum. We used linear mixed effects (LME) models to analyze overall infant anthropometry during the first 6 weeks of life. Additionally, we considered effect modification by infant sex. Results We observed weak positive associations between all OPE metabolites and GWG. In LME models, BDCPP was associated with increased infant length (β = 0.44 cm, 95%CI = 0.01, 0.87) and weight in males (β = 0.14 kg, 95%CI = 0.03, 0.24). BDCPP was also associated with increased food responsiveness (β = 0.23, 95%CI = 0.06, 0.40). DPHP was inversely associated with infant abdominal circumference (β = − 0.50 cm, 95%CI = − 0.86, − 0.14) and female weight (β = − 0.19 kg, 95%CI = − 0.36, − 0.02), but positively associated with weekly growth in iliac skinfold thickness (β = 0.10 mm/wk., 95%CI = 0.02, 0.19). Further, DPHP was weakly associated with increased feeding speed. BCEP was associated with greater infant thigh skinfold thickness (β = 0.34 mm, 95%CI = 0.16, 0.52) and subscapular skinfold thickness in males (β = 0.14 mm, 95%CI = 0.002, 0.28). Conclusions Collectively, these findings suggest that select OPEs may affect infant anthropometry and feeding behavior, with the most compelling evidence for BDCPP and DPHP.

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