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Fertility and pregnancy after bariatric surgery

David W Ouyang, MD
Section Editors
Charles J Lockwood, MD, MHCM
Daniel Jones, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Bariatric surgery has become an increasingly utilized and effective approach for achieving sustainable weight loss, as well as reducing morbidities associated with severe obesity. More than 80 percent of bariatric procedures are performed in women, and approximately half of these are performed in reproductive aged women [1]. Thus, it has become increasingly common for women who have undergone bariatric surgery to present for preconceptional counseling or prenatal care.

The data presented in this topic review have been derived from retrospective studies, case reports, and personal experience. There are no available data from randomized trials or prospective cohort studies. Other issues related to bariatric surgery are discussed separately (refer to appropriate topic reviews).


Bariatric surgical procedures can be divided into two varieties, malabsorptive and restrictive. This difference is based upon the anatomic configuration of the procedure, which in turn contributes to the mechanisms by which they induce weight loss (table 1). Some procedures have both a restrictive and malabsorptive component (eg, Roux-en-Y gastric bypass). (See "Bariatric procedures for the management of severe obesity: Descriptions".)

Clinical implications — It is important for the clinician to know which procedure a woman has undergone in order to counsel her about potential complications and reproductive issues, as well as possible interventions. Multiple anatomic and physiologic changes that occur after bariatric surgery can affect absorption of medications [2]. As examples:

If the patient has undergone placement of a laparoscopic adjustable gastric band procedure, the volume of fluid within the band can be adjusted during pregnancy to help manage pregnancy-related nausea and vomiting and prevent excessive or inadequate gestational weight gain [3,4]. The band is tightened by adding more fluid to a reservoir attached to the band, which creates increased pressure and tightens the band. The band is loosened by removing fluid from the reservoir, which reduces pressure in the band and loosens it. The best management of the gastric band during pregnancy has not been determined and there is variation in care [5].

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Literature review current through: Nov 2017. | This topic last updated: Nov 13, 2017.
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