Archives of Gynecology and Obstetrics

, Volume 300, Issue 1, pp 145–152 | Cite as

Maternal impacts and perinatal outcomes after three types of bariatric surgery at a single institution

  • Atsushi WatanabeEmail author
  • Yosuke Seki
  • Hidenori Haruta
  • Eri Kikkawa
  • Kazunori Kasama
General Gynecology



Bariatric surgery is widely known to improve pregnancy outcomes and to increase the risk of having small for gestational age neonates. However, the specific causes of neonatal growth restriction are still unclear. This study aimed to investigate the impacts of bariatric surgery on pregnancy and perinatal status at a single institution.


24 women delivered singleton births among the 193 reproductive-aged women who underwent bariatric surgery. We classified the surgery into three types: laparoscopic adjustable gastric banding (LAGB; n = 6), laparoscopic sleeve gastrectomy (LSG; n = 5), and malabsorptive surgery (MS; n = 13), and investigated the pregnancy complications and perinatal impacts.


The median maternal weight gain after LAGB was 12.5 kg (LSG 6.9 kg, MS 9.0 kg). Gestational hypertension was observed in half of the women who underwent LAGB, but in none of those who underwent MS. No significant difference in neonatal birth weight was observed between the LAGB (median 3272 g) and LSG (median 3005 g) groups. The maternal impact after MS was a remarkable decrease in hemoglobin during prepregnancy (median 1.9 g/dl). About 69% of women developed gestational anemia after MS, and their neonatal birth weight was the lowest (median 2660 g). However, the birth weight of neonates delivered by mothers without anemia after undergoing MS was similar to that of those delivered by mothers after undergoing other types of bariatric surgery (median 3037 g).


Maternal anemia after MS may lead to low neonatal birth weight, which could be attributed to the large-scale reduction in maternal micronutrient levels.


Bariatric surgery Gestational anemia Neonatal birth weight Sleeve gastrectomy 


Author contributions

AW and KK conceived of the presented idea. AW designed the study, and wrote the initial draft of the manuscript. EK and HH supported to analysis and interpretation of data, and assisted in the preparation of the manuscript. SY and KK supervised the findings of this work. All other authors have contributed to data collection and interpretation, and critically reviewed the manuscript. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with ethical standards

Conflict of interest

All other authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.


  1. 1.
    Sharma R, Biedenharm KR, Fender JM et al (2013) Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol 11:66CrossRefGoogle Scholar
  2. 2.
    Ovesen PG, Jensen DM, Damm P et al (2015) Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes: a nation-wide study. J Matern Fetal Neonatal Med 28(14):1720–1724CrossRefGoogle Scholar
  3. 3.
    Weiss JL, Malone FD, Emig D et al (2004) Obesity, obstetric complications and cesarean delivery rate-a population-based screening study. Am J Obstet Gynecol 190(4):1091–1097CrossRefGoogle Scholar
  4. 4.
    Mcdonald SD, Han Z, Mulla S et al (2010) Overweight and obesity in mothers and risk of preterm birth and low birth weight in infants: systematic review and meta-analysis. BMJ 341:c3428CrossRefGoogle Scholar
  5. 5.
    Blomberg MI, Källén B (2010) Maternal obesity and morbid obesity: the risk for birth defects in the offspring. Birth Defects Res A Clin Mol Teratol 88(1):35–40Google Scholar
  6. 6.
    Ribaric G, Buchwald JN, McGlennon TW (2014) Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg 24:437–455CrossRefGoogle Scholar
  7. 7.
    American College of Obstetricians and Gynecologists (2005) ACOG Committee Opinion 315: obesity in pregnancy. Obstet Gynecol 106:671–675CrossRefGoogle Scholar
  8. 8.
    Chevrot A, Kayem G, Coupaye M et al (2016) Impact of bariatric surgery on fetal growth restriction: experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol 214(5):655. e1-7CrossRefGoogle Scholar
  9. 9.
    Galazis N, Docheva N, Simillis C et al (2014) Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 181:45–53CrossRefGoogle Scholar
  10. 10.
    Roos N, Neovius M, Cnattinguis S et al (2013) Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study. BMJ 347:f6460CrossRefGoogle Scholar
  11. 11.
    Johansson K, Cnattinguis S, Näslund I et al (2015) Outcomes of pregnancy after bariatric surgery. N Engl J Med 372(9):814–824CrossRefGoogle Scholar
  12. 12.
    Angrisani L, Santonicola A, lovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey. Obes Surg 2017;27(9): 2279–89.Google Scholar
  13. 13.
    International Association of Diabetes and Pregnancy Study Groups (2010) Recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682CrossRefGoogle Scholar
  14. 14.
    Rsmussen KM, Yaktine AL (2009) Weight gain during pregnancy: reexamining the guidelines, report brief, institute of medicine (IOM) of national academiesGoogle Scholar
  15. 15.
    Mechanick JI, Youdim A, Jones DB et al (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists: The Obesity Society, and American Society for Metabolic and Bariatric Surgery. Obesity 21:S1–27CrossRefGoogle Scholar
  16. 16.
    Carelli AM, Ren CJ, Youn HA et al (2011) Impact of laparoscopic adjustable gastric banding on pregnancy, maternal weight, and neonatal health. Obes Surg 21(10):1552–1558CrossRefGoogle Scholar
  17. 17.
    Skull AJ, Slater GH, Duncombe JE et al (2004) Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes. Obes Surg 14(2):230–235CrossRefGoogle Scholar
  18. 18.
    Heude B, Thiébaugeorges O, Goua V et al (2012) Pre-pregnancy body mass index and weight gain during pregnancy: relation with gestational diabetes and hypertension, and birth outcomes. Matern Child Health J 16(2):355–363CrossRefGoogle Scholar
  19. 19.
    Cable CT, Colbert CY, Showalter T et al (2011) Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? Surg Obes Relat Dis 7(2):134–139CrossRefGoogle Scholar
  20. 20.
    Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF (2008) Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 18(3):288–293CrossRefGoogle Scholar
  21. 21.
    Del Villar Madrigal E, Neme-Yunes Y, Clavellina-Gaytan D et al (2015) Anemia after Roux-en-Y gastric bypass: how feasible to eliminate the risk by proper supplementation? Obes Surg 25(1):80–84CrossRefGoogle Scholar
  22. 22.
    Kaur M, Chauhan A, Manzar MD et al (2015) Maternal anaemia and neonatal outcome: a prospective study on urban pregnant women. J Clin Diagn Res 9(12):QC04–8Google Scholar
  23. 23.
    Haider BA, Olofin I, Wang M et al (2013) Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 346:f3443CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryJikei University School of MedicineTokyoJapan
  2. 2.Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
  3. 3.Clinical Institute of Digestive Disease Surgical BranchJichi Medical UniversityShimotsukeshiJapan

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