Timing of Gestation After Laparoscopic Sleeve Gastrectomy (LSG): Does It Influence Obstetrical and Neonatal Outcomes of Pregnancies?

  • Seda SancakEmail author
  • Özgen Çeler
  • Elif Çırak
  • Aziz Bora Karip
  • M. Tumiçin Aydın
  • Nuriye Esen Bulut
  • M. Mahir Fersahoğlu
  • Hasan Altun
  • Kemal Memişoğlu
Original Contributions



We aimed to evaluate the effect of pregnancy timing after laparoscopic sleeve gastrectomy (LSG) on maternal and fetal outcomes.


Women with LSG were stratified into two groups with surgery-to-conception intervals of ≤ 18 months (early group) or > 18 months (late group). Only the first delivery after LSG was included in this study. We compared maternal characteristics, pregnancy, and neonatal outcomes and adherence to the Institute of Medicine’s (IOM) recommendations for gestational weight gain (GWG) in the two groups.


Fifteen patients conceived ≤ 18 months after surgery, with a mean surgery-to-conception interval of 5.6 ± 4.12 months, and 29 women conceived > 18 months following LSG, with a mean surgery-to-conception interval of 32.31 ± 11.38 months, p < 0.05. There was no statistically significant difference between the two groups regarding birth weight, gestational age, cesarean deliveries (CD), preterm birth, whether their child was small or large for their gestational age, or in the need of neonatal intensive care. There was no correlation between mean weight loss from operation till conception, mean weight gain during pregnancy, and mean body mass index (BMI) at conception between birth weight in either study group. Inadequate and normal GWG was significantly higher in the early group, whereas excessive GWG was significantly higher in the late group (X2, 20.780; p = < 0.001).


The interval between LSG and conception did not impact maternal and neonatal outcomes. Pregnancy after LSG was overall safe and well-tolerated.


Laparoscopic sleeve gastrectomy Surgery-to-conception time interval Perinatal Maternal outcomes IOM 


Author Contribution

Seda Sancak, as principal investigator, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with Ethical Standards

To conduct the study, the institutional review board approval was obtained. The study was carried out in accordance with the Declaration of Helsinki (2013) of the World Medical Association.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. 2000.Google Scholar
  2. 2.
    Yumuk VD. Prevalence of obesity in Turkey. Obes Rev. 2005;6:9–10.CrossRefGoogle Scholar
  3. 3.
    Satman I, Omer B, Tutuncu Y, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169–80.CrossRefGoogle Scholar
  4. 4.
    Gundogan K, Bayram F, Gedik V, et al. Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults. Arch Med Sci. 2013;9(2):243–53.CrossRefGoogle Scholar
  5. 5.
    ACOG. Committee opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol. 2005;106(3):671–5.CrossRefGoogle Scholar
  6. 6.
    Costa MM, Belo S, Souteiro P, et al. Pregnancy after bariatric surgery: maternal and fetal outcomes of 39 pregnancies and a literature review. J Obstet Gynaecol Res. 2018;44(4):681–90.CrossRefGoogle Scholar
  7. 7.
    Gastrointestinal Surgery for Severe Obesity. National Institutes of Health consensus development conference statement. Am J Clin Nutr. 1992;55:615S–9.CrossRefGoogle Scholar
  8. 8.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefGoogle Scholar
  9. 9.
    Papamargaritis D, Koukoulis G, Sioka E, et al. Dumping symptoms and incidence of hypoglycaemia after provocation test at 6 and 12 months after laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(10):1600–6.CrossRefGoogle Scholar
  10. 10.
    Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.CrossRefGoogle Scholar
  11. 11.
    Kassir R, Goiset MP, Williet N, et al. Bariatric surgery and pregnancy: what outcomes? Int J Surg. 2016;36(Pt A):66–7.CrossRefGoogle Scholar
  12. 12.
    Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018;218(6):573–80.CrossRefGoogle Scholar
  13. 13.
    Kjaer MM, Nilas L. Pregnancy after bariatric surgery--a review of benefits and risks. Acta Obstet Gynecol Scand. 2013;92(3):264–71.CrossRefGoogle Scholar
  14. 14.
    Wax JR, Pinette MG, Cartin A, et al. Female reproductive issues following bariatric surgery. Obstet Gynecol Surv. 2007;62(9):595–604.CrossRefGoogle Scholar
  15. 15.
    American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113(6):1405–13.CrossRefGoogle Scholar
  16. 16.
    Friedman D, Cuneo S, Valenzano M, et al. Pregnancies in an 18-year follow-up after biliopancreatic diversion. Obes Surg. 1995;5(3):308–13.CrossRefGoogle Scholar
  17. 17.
    Kjær MM, Nilas L. Timing of pregnancy after gastric bypass-a national register-based cohort study. Obes Surg. 2013;23(8):1281–5.CrossRefGoogle Scholar
  18. 18.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefGoogle Scholar
  19. 19.
    Mechanick JI, Youdim A, Jones DB, et al. 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 & Bariatric Surgery. Endocr Pract. 2013;19(2):337–72.CrossRefGoogle Scholar
  20. 20.
    Karmon A, Sheiner E. Timing of gestation after bariatric surgery: should women delay pregnancy for at least 1 postoperative year? Am J Perinatol. 2008;25(6):331–3.CrossRefGoogle Scholar
  21. 21.
    Sheiner E, Edri A, Balaban E, et al. Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery. Am J Obstet Gynecol. 2011;204(1):50.e1–6.CrossRefGoogle Scholar
  22. 22.
    Dixon JB, Dixon ME, O’Brien PE. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol. 2005;106(5 Pt 1):965–72.CrossRefGoogle Scholar
  23. 23.
    Dao T, Kuhn J, Ehmer D, et al. Pregnancy outcomes after gastric-bypass surgery. Am J Surg. 2006;192(6):762–6.CrossRefGoogle Scholar
  24. 24.
    Patel JA, Patel NA, Thomas RL, et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(1):39–45.CrossRefGoogle Scholar
  25. 25.
    Wax JR, Cartin A, Wolff R, et al. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008;18(12):1517–21.CrossRefGoogle Scholar
  26. 26.
    González I, Rubio MA, Cordido F, et al. Maternal and perinatal outcomes after bariatric surgery: a Spanish multicenter study. Obes Surg. 2015;25(3):436–42.CrossRefGoogle Scholar
  27. 27.
    Harreiter J, Schindler K, Bancher-Todesca D, et al. Management of pregnant women after bariatric surgery. J Obes. 2018;2018:4587064. eCollection 2018. ReviewCrossRefGoogle Scholar
  28. 28.
    Basbug A, Ellibeş Kaya A, Dogan S, et al. Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes? J Matern Fetal Neonatal Med. 2018;17:1–7.Google Scholar
  29. 29.
    Stentebjerg LL, Andersen LLT, Renault K, et al. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass. J Matern Fetal Neonatal Med. 2017;30(10):1182–8.CrossRefGoogle Scholar
  30. 30.
    Rasteiro C, Araújo C, Cunha S, et al. Influence of time interval from bariatric surgery to conception on pregnancy and perinatal outcomes. Obes Surg. 2018;28(11):3559–66Google Scholar
  31. 31.
    Nørgaard LN, Gjerris ACR, Kirkegaard I, et al. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish National Cohort Study. PLoS One. 2014;9(3):e90317.CrossRefGoogle Scholar
  32. 32.
    Ducarme G, Parisio L, Santulli P, et al. Neonatal outcomes in pregnancies after bariatric surgery: a retrospective multi-centric cohort study in three French referral centers. J Matern Fetal Neonatal Med. 2013;26(3):275–8.CrossRefGoogle Scholar
  33. 33.
    Ducarme G, Chesnoy V, Lemarié P, et al. Pregnancy outcomes after laparoscopic sleeve gastrectomy among obese patients. Int J Gynaecol Obstet. 2015;130(2):127–31.CrossRefGoogle Scholar
  34. 34.
    Gaskins AJ, Toth TL, Chavarro JE. Prepregnancy nutrition and early pregnancy outcomes. Curr Nutr Rep. 2015;4(3):265–72.CrossRefGoogle Scholar
  35. 35.
    Duran A, Sáenz S, Torrejón MJ, et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care. 2014;37(9):2442–50.CrossRefGoogle Scholar
  36. 36.
    Bebber FE, Rizzolli J, Casagrande DS, et al. Pregnancy after bariatric surgery: 39 pregnancies follow-up in a multidisciplinary team. Obes Surg. 2011;21(10):1546–51.CrossRefGoogle Scholar
  37. 37.
    Kaska L, Kobiela J, Abacjew-Chmylko A, et al. Nutrition and pregnancy after bariatric surgery. ISRN Obes. 2013;2013:492060.Google Scholar
  38. 38.
    Aricha-Tamir B, Weintraub AY, Levi I, et al. Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery. Surg Obes Relat Dis. 2012;8(4):434–9.CrossRefGoogle Scholar
  39. 39.
    Marceau P, Kaufman D, Biron S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004;14(3):318–24.CrossRefGoogle Scholar
  40. 40.
    Parent B, Martopullo I, Weiss NS, et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg. 2017;152(2):1–8.CrossRefGoogle Scholar
  41. 41.
    Health statistics yearbook 2015. Nomenclature of territorial units for statistics and provinces. Republic of Turkey: Ministry of Health. 2015Google Scholar
  42. 42.
    Yi XY, Li QF, Zhang J, et al. A meta-analysis of maternal and fetal outcomes of pregnancy after bariatric surgery. Int J Gynaecol Obstet. 2015;130(1):3–9.CrossRefGoogle Scholar
  43. 43.
    Sheiner E, Levy A, Silverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol. 2004;190(5):1335–40.CrossRefGoogle Scholar
  44. 44.
    Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health. 2001;91(3):436–40.CrossRefGoogle Scholar
  45. 45.
    American College of Obstetricians and Gynecologists. ACOG committee opinion no. 549: obesity in pregnancy. Obstet Gynecol. 2013;121:213–7.CrossRefGoogle Scholar
  46. 46.
    Ducarme G, Revaux A, Rodrigues A, et al. Obstetric outcome following laparoscopic adjustable gastric banding. Int J Gynaecol Obstet. 2007;98(3):244–7.CrossRefGoogle Scholar
  47. 47.
    Lapolla A, Marangon M, Dalfrà MG, et al. Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding. Obes Surg. 2010;20(9):1251–7.CrossRefGoogle Scholar
  48. 48.
    Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009;15(2):189–201.CrossRefGoogle Scholar
  49. 49.
    Yau PO, Parikh M, Saunders JK, et al. Pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. Surg Obes Relat Dis. 2017;13(11):1899–905.CrossRefGoogle Scholar
  50. 50.
    Dell'Agnolo CM, Cyr C, de Montigny F, et al. Pregnancy after bariatric surgery: obstetric and perinatal outcomes and the growth and development of children. Obes Surg. 2015;25(11):2030–9.CrossRefGoogle Scholar
  51. 51.
    Olafsdottir AS, Skuladottir GV, Thorsdottir I, et al. Maternal diet in early and late pregnancy in relation to weight gain. Int J Obes. 2006;30(3):492–9.CrossRefGoogle Scholar
  52. 52.
    Sjöström L, Narbro K, Sjöström CD. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Fatih Sultan Mehmet Education and Research Hospital, Endocrinology and Metabolism Disorders, Department of Internal MedicineUniversity of Health SciencesİstanbulTurkey
  2. 2.Fatih Sultan Mehmet Education and Research Hospital, Department of Internal MedicineUniversity of Health SciencesİstanbulTurkey
  3. 3.General Surgery Clinic, Fatih Sultan Mehmet Education and Research HospitalUniversity of Health SciencesIstanbulTurkey
  4. 4.General Surgery ClinicLiv HospitalIstanbulTurkey

Personalised recommendations