Impact of Bariatric Surgery on Female Reproductive Health and Maternal Outcomes

  • S. Christinajoice
  • Shivanshu Misra
  • Siddhartha Bhattacharya
  • S. Saravana Kumar
  • B. Deepa Nandhini
  • C. Palanivelu
  • P. Praveen RajEmail author
Original Contributions



Obesity has a derogatory effect on female reproductive health. Obesity contributes to difficulty in natural conception, increased risk of pregnancy-associated complications, miscarriages, congenital anomalies, and also the long-term negative impact on both mother and the child.


Our study aimed to analyze and assess the reproductive health-associated outcomes of females who underwent bariatric surgery.


We performed a retrospective analysis from a prospectively collected database from June 2013 to June2016. Out of 71 females studied, 45 patients (63.5%) had completed 3 years of follow-up. The data were collected from inpatient and outpatient records. Patients were studied under three groups (A, patients with polycystic ovarian disease (PCOD) symptoms; B, patients with primary infertility; and C, patients who conceived after bariatric surgery that were included in groups A and B).


Out of 45 patients studied, 40 patients underwent laparoscopic sleeve gastrectomy (LSG), four patients underwent laparoscopic Roux-en-Y gastric bypass (RYGB), and one patient underwent laparoscopic adjustable gastric banding (LAGB). The mean BMI of the patients was 43.64 ± 6.8 kg/m2. PCOD symptoms improved symptomatically (p = 0.001) after surgery in the group. Seven (43.75%) primary infertility patients conceived after surgery. Three (42.9%) patients conceived naturally while 4 (57.1%) conceived with ART in group B. Out of total population of 45 in group C, percentages of patients who delivered baby with short gestational age (SGA), low birth weight (LBW), normal vaginal deliveries (NVD), and maternal anemia were 63.15%,47.3%,73.4%, and26.3%, respectively.


Obesity is closely associated with primary infertility and PCOD. Menstrual abnormalities associated with PCOD significantly improve after bariatric surgery with significant improvement in fertility along with maternal outcomes.


BS bariatric surgery LSG, laparoscopic sleeve gastrectomy RYGB, Roux-en-Y gastric bypass PCOD Small for gestational age Low birth weight ART, assisted reproductive technique 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


Consent had been attained from the patients before the surgery

Ethical Clearance

The institutional ethical committee had approved the study.


  1. 1.
    WHO. Obesity and overweight. [cited 2019 Jun 14]. Available from:
  2. 2.
    Yoon K-H, Lee J-H, Kim J-W, Cho JH, Choi Y-H, Ko S-H, et al. Epidemic obesity and type 2 diabetes in Asia. Lancet. 2006 [cited 2019 Aug 2];368(9548):1681–8. Available from: Scholar
  3. 3.
    Ramachandran A, Snehalatha C. Rising burden of obesity in Asia. J Obes. 2010 [cited 2019 Aug 2];2010. Available from:
  4. 4.
    Helble M, Sato A. Wealthy but unhealthy: overweight and obesity in Asia and the Pacific: trends, costs, and policies for better health. 2030 [cited 2019 Jul 30]. Available from:
  5. 5.
    Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005 [cited 2019 Jul 30];352(12):1223–36. Available from: Scholar
  6. 6.
    Leddy MA, Power ML, Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol. 2008 [cited 2019 Jun 14];1(4):170–8. Available from:
  7. 7.
    Fitzsimons KJ, Modder J, Greer IA. Obesity in pregnancy: risks and management. Obstet Med. 2009 [cited 2019 Jun 14];2(2):52–62. Available from: Scholar
  8. 8.
    Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992 [cited 2019 Jul 30];55(2):615S-619S. Available from:
  9. 9.
    Sjöholm K, Anveden A, Peltonen M, Jacobson P, Romeo S, Svensson P-A, et al. Evaluation of current eligibility criteria for bariatric surgery: diabetes prevention and risk factor changes in the Swedish obese subjects (SOS) study. Diabetes Care. 2013 [cited 2019 Jul 30];36(5):1335–40. Available from: Scholar
  10. 10.
    About polycystic ovary syndrome (PCOS) | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. [cited 2019 Jun 14]. Available from:
  11. 11.
  12. 12.
    Stankiewicz M, Norman R. Diagnosis and management of polycystic ovary syndrome. Drugs. 2006 [cited 2019 Jun 14];66(7):903–12. Available from: Scholar
  13. 13.
    Wang R, Mol BWJ. The Rotterdam criteria for polycystic ovary syndrome: evidence-based criteria? Hum Reprod. 2017 [cited 2019 Jun 19];32(2):261–4. Available from: Scholar
  14. 14.
    Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004 [cited 2019 Aug 2];81(1):19–25. Available from:
  15. 15.
    Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009∗. Fertil Steril. 2009 [cited 2019 Jul 23];92(5):1520–4. Available from:
  16. 16.
    Schlaudecker EP, Munoz FM, Bardají A, Boghossian NS, Khalil A, Mousa H, et al. Small for gestational age: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine. 2017 [cited 2019 Jul 27];35(48 Pt A):6518–28. Available from:
  17. 17.
    WHO | Physical status: the use and interpretation of anthropometry. WHO. 2013 [cited 2019 Jul 27]; Available from:
  18. 18.
    American College of Obstetricians and Gynecologists. ACOG committee opinion. American College of Obstetricians and Gynecologists; [cited 2019 Jul 27]. Available from: = false.
  19. 19.
    Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, et al. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2017 [cited 2019 Jul 17];35(48 Pt A):6492–500. Available from:
  20. 20.
    Sciarra JJ, Holzgreve W, Downes E. The global library of women’s medicine. Sapiens Global Library; [cited 2019 Jul 27]. Available from:
  21. 21.
    Causes of female infertility - UpToDate. [cited 2019 Jul 20]. Available from:
  22. 22.
    Balen AH, Anderson RA, Policy & Practice Committee of the BFS. Impact of obesity on female reproductive health: British Fertility Society, Policy and Practice Guidelines. Hum Fertil. 2007 [cited 2019 Jul 19];10(4):195–206. Available from:
  23. 23.
    Brugo-Olmedo S, Chillik C, Kopelman S. Definition and causes of infertility. Vol. 2, Reproductive BioMedicine Online. [cited 2019 Jul 20]. Available from:
  24. 24.
    Choudhary A, Jain S, Chaudhari P. Prevalence and symptomatology of polycystic ovarian syndrome in Indian women: is there a rising incidence? Int J Reprod Contraception, Obstet Gynecol. 2017 [cited 2019 Jun 14];6(11):4971. Available from:
  25. 25.
    Homburg R. Polycystic ovary syndrome--from gynaecological curiosity to multisystem endocrinopathy. Hum Reprod. 1996 [cited 2019 Aug 2];11(1):29–39. Available from: Scholar
  26. 26.
    Chandrasekaran S, Sagili H. Metabolic syndrome in women with polycystic ovary syndrome. Obstet Gynaecol. 2018 [cited 2019 Aug 2];20(4):245–52. Available from: Scholar
  27. 27.
    Li Y, Lin H, Pan P, Yang D, Zhang Q. Impact of central obesity on women with polycystic ovary syndrome undergoing in vitro fertilization. Biores Open Access. 2018 [cited 2019 Jul 20];7(1):116–22. Available from: Scholar
  28. 28.
    Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989 [cited 2019 Jul 23];38(9):1165–74. Available from: Scholar
  29. 29.
    Lord J, Thomas R, Fox B, Acharya U, Wilkin T. The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome. BJOG An Int J Obstet Gynaecol. 2006 [cited 2019 Jul 23];113(10):1203–9. Available from: Scholar
  30. 30.
    Sam S. Obesity and polycystic ovary syndrome. Obes Manag. 2007 [cited 2019 Jun 19];3(2):69–73. Available from: Scholar
  31. 31.
    Balen A. The pathophysiology of polycystic ovary syndrome: trying to understand PCOS and its endocrinology. Best Pract Res Clin Obstet Gynaecol. 2004 [cited 2019 Aug 2];18(5):685–706. Available from:
  32. 32.
    Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006 May [cited 2019 Jul 23];85(5):1319–40. Available from: Scholar
  33. 33.
    Haffner SM. Sex hormone-binding protein, hyperinsulinemia, insulin resistance and noninsulin-dependent diabetes. Horm Res. 1996 [cited 2019 Aug 7];45(3–5):233–7. Available from: Scholar
  34. 34.
    Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev. 2016 [cited 2019 Jul 23];37(5):467–520. Available from: Scholar
  35. 35.
    Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health. 2011 [cited 2019 Jul 23];3:25–35. Available from:
  36. 36.
    Escobar-Morreale HF, Botella-Carretero JI, Álvarez-Blasco F, Sancho J, San Millán JL. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005 [cited 2019 Jul 23];90(12):6364–9. Available from: Scholar
  37. 37.
    Skubleny D, Switzer NJ, Gill RS, Dykstra M, Shi X, Sagle MA, et al. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Surg. 2016 [cited 2019 Jul 23];26(1):169–76. Available from: Scholar
  38. 38.
    Fertility Rate By Country 2019. [cited 2019 Jun 14]. Available from:
  39. 39.
    Rich-Edwards JW, Goldman MB, Willett WC, Hunter DJ, Stampfer MJ, Colditz GA, et al. Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol. 1994 [cited 2019 Jun 14];171(1):171–7. Available from: Scholar
  40. 40.
    Khan R, Dawlatly B, Chappatte O. Pregnancy outcome following bariatric surgery. Obstet Gynaecol. 2013 [cited 2019 Jun 14];15(1):37–43. Available from: Scholar
  41. 41.
    Grodstein F, Goldman MB, Cramer DW. Body mass index and ovulatory infertility. Epidemiology. 1994 [cited 2019 Aug 6];5(2):247–50. Available from: Scholar
  42. 42.
    Willis D, Mason H, Gilling-Smith C, Franks S. Modulation by insulin of follicle-stimulating hormone and luteinizing hormone actions in human granulosa cells of normal and polycystic ovaries. J Clin Endocrinol Metab. 1996 [cited 2019 Aug 6];81(1):302–9. Available from: Scholar
  43. 43.
    Hillier SG. Current concepts of the roles of follicle stimulating hormone and luteinizing hormone in folliculogenesis. Hum Reprod. 1994 [cited 2019 Aug 6];9(2):188–91. Available from: Scholar
  44. 44.
    Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A. Obesity and reproductive disorders in women. Hum Reprod Update. 2003 [cited 2019 Aug 6];9(4):359–72. Available from: Scholar
  45. 45.
    Bellver J, Melo MAB, Bosch E, Serra V, Remohí J, Pellicer A. Obesity and poor reproductive outcome: the potential role of the endometrium. Fertil Steril. 2007 [cited 2019 Aug 6];88(2):446–51. Available from: Scholar
  46. 46.
    Overview | Weight management before, during and after pregnancy | Guidance | NICE. [cited 2019 Jun 14]; Available from: 27.
  47. 47.
    Merhi ZO. Impact of bariatric surgery on female reproduction. Fertil Steril. 2009 [cited 2019 Jul 19];92(5):1501–8. Available from: Scholar
  48. 48.
    Marceau P, Kaufman D, Biron S, Hould F-S, Lebel S, Marceau S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004 [cited 2019 Jul 24];14(3):318–24. Available from: Scholar
  49. 49.
    Deitel M, Stone E, Kassam HA, Wilk EJ, Sutherland DJ. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988 [cited 2019 Jul 24];7(2):147–53. Available from:
  50. 50.
    Wax JR, Cartin A, Wolff R, Lepich S, Pinette MG, Blackstone J. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008 [cited 2019 Jun 17];18(12):1517–21. Available from: Scholar
  51. 51.
    Patel JA, Patel NA, Thomas RL, Nelms JK, Colella JJ. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008 [cited 2019 Jul 25];4(1):39–45. Available from: Scholar
  52. 52.
    Richards DS, Miller DK, Goodman GN. Pregnancy after gastric bypass for morbid obesity. J Reprod Med. 1987 [cited 2019 Jul 25];32(3):172–6. Available from:
  53. 53.
    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 [cited 2019 Jun 17];214(5):655.e1-655.e7. Available from: Scholar
  54. 54.
    Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. Biomed Res Int. 2014 [cited 2019 Jul 25];2014:640291. Available from: Scholar
  55. 55.
    Baron CM, Girling LG, Mathieson AL, Menticoglou SM, Seshia MM, Cheang MS, et al. Obstetrical and neonatal outcomes in obese parturients. J Matern Neonatal Med. 2010 [cited 2019 Jul 25];23(8):906–13. Available from: Scholar
  56. 56.
    Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. 2004 [cited 2019 Jul 25]; Available from:
  57. 57.
    Kaplan-Sturk R, Åkerud H, Volgsten H, Hellström-Westas L, Wiberg-Itzel E. Outcome of deliveries in healthy but obese women: obesity and delivery outcome. BMC Res Notes. 2013 [cited 2019 Jul 25];6:50. Available from: Scholar
  58. 58.
    Zhang J, Bricker L, Wray S, Quenby S. Poor uterine contractility in obese women. BJOG An Int J Obstet Gynaecol. 2007 [cited 2019 Aug 7];114(3):343–8. Available from: Scholar
  59. 59.
    Wuntakal R, Kaler M, Hollingworth T. Women with high BMI: should they be managed differently due to antagonising action of leptin in labour? Med Hypotheses. 2013 Jun [cited 2019 Aug 7];80(6):767–8. Available from:
  60. 60.
    Jie Zhang, Kendrick A, Quenby S, Wray S. Contractility and calcium signaling of human myometrium are profoundly affected by cholesterol manipulation: implications for labor? Reprod Sci. 2007 [cited 2019 Aug 7];14(5):456–66. Available from: Scholar
  61. 61.
    The National Family Health Survey (NFHS-3) - India - Health education to villages. [cited 2019 Jun 17]. Available from:
  62. 62.
    National Family Health Survey. [cited 2019 Jun 17]. Available from:
  63. 63.
    Berendzen JA, Howard BC. Association between cesarean delivery rate and body mass index. Tenn Med. 2013 [cited 2019 Jun 17];106(1):35–7, 42. Available from:
  64. 64.
    Lapolla A, Marangon M, Dalfrà MG, Segato G, De Luca M, Fedele D, et al. Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding. Obes Surg. 2010 [cited 2019 Jul 25];20(9):1251–7. Available from: Scholar
  65. 65.
    Kjær MM, Lauenborg J, Breum BM, Nilas L. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013 [cited 2019 Jun 17];208(6):464.e1-464.e5. Available from: Scholar
  66. 66.
    Josefsson A, Blomberg M, Bladh M, Frederiksen SG, Sydsjö G. Bariatric surgery in a national cohort of women: sociodemographics and obstetric outcomes. Am J Obstet Gynecol. 2011 [cited 2019 Jun 17];205(3):206.e1-206.e8. Available from: Scholar
  67. 67.
    Munasinghe S, van den Broek N. Anaemia in pregnancy in Malawi- a review. Malawi Med J. 2006 [cited 2019 Aug 6];18(4):160–74. Available from:
  68. 68.
    Vanamala VG, Rachel A, Pakyanadhan S. Incidence and outcome of anemia in pregnant women: a study in a tertiary care centre. Int J Reprod Contraception, Obstet Gynecol. 2018 [cited 2019 Jun 17];7(2):462. Available from:
  69. 69.
    Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009 [cited 2019 Jun 17];130(5):627–33. Available from:
  70. 70.
    Belogolovkin V, Salihu HM, Weldeselasse H, Biroscak BJ, August EM, Mbah AK, et al. Impact of prior bariatric surgery on maternal and fetal outcomes among obese and non-obese mothers. Arch Gynecol Obstet. 2012 [cited 2019 Jul 27];285(5):1211–8. Available from: Scholar
  71. 71.
    Galazis N, Docheva N, Simillis C, Nicolaides KH. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014 [cited 2019 Jun 17];181:45–53. Available from: Scholar
  72. 72.
    Iavazzo C, Ntziora F, Rousos I, Paschalinopoulos D. Complications in pregnancy after bariatric surgery. Arch Gynecol Obstet. 2010 [cited 2019 Aug 7];282(2):225–7. Available from: Scholar
  73. 73.
    Karmon A, Sheiner E. Timing of gestation after bariatric surgery: should women delay pregnancy for at least 1 postoperative year? Am J Perinatol. 2008 [cited 2019 Aug 7];25(6):331–3. Available from: Scholar
  74. 74.
    Mansourian AR. Thyroid function tests during first-trimester of pregnancy: a review of literature. Pakistan J Biol Sci. 2010 [cited 2019 Aug 7];13(14):664–73. Available from: = pjbs.2010.664.673.PubMedCrossRefGoogle Scholar
  75. 75.
    Leung TY, Chan LW, Leung TN, Fung TY, Sahota DS, Lau TK. First-trimester maternal serum levels of placental hormones are independent predictors of second-trimester fetal growth parameters. Ultrasound Obstet Gynecol. 2006 [cited 2019 Aug 7];27(2):156–61. Available from: Scholar
  76. 76.
    Kominiarek MA. Preparing for and managing a pregnancy after bariatric surgery. Semin Perinatol. 2011 [cited 2019 Aug 7];35(6):356–61. Available from: Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Bariatric and Metabolic SurgeryGEM Hospital & Research CenterCoimbatoreIndia

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