The association of higher offspring early-childhood weight gain with prepregnancy metabolic and bariatric surgery

Objective

The objective of this study was to assess maternal gestational outcomes and offspring growth trajectories following prepregnancy metabolic and bariatric surgery (MBS) compared with non-MBS controls.

Methods

Single-center deliveries between January 2020 and March 2023 with prepregnancy Roux-en-Y gastric bypass (herein referred to as “bypass”), sleeve gastrectomy (herein referred to as “sleeve”), and non-MBS controls were included. Offspring growth trajectories were compared with the World Health Organization child growth standards. Linear mixed models assessed MBS-bypass and MBS-sleeve offspring weight, length, and BMI trajectories with a prepregnancy BMI 27 to 37 kg/m² and propensity score-matched controls.

Results

The study included 440 participants with prepregnancy MBS (MBS-bypass, 185; MBS-sleeve, 225; 76% Hispanic/Latino) and 13,434 non-MBS controls. Gestational weight gain and gestational diabetes mellitus were similar, whereas hypertensive disorders of pregnancy were more common after MBS. The post-MBS offspring had lower birth weight but higher weight gain at 24 months (sleeve, +1.4 kg [95% CI: 1.0–1.9]; bypass, +0.5–0.7 kg [95% CI: 0.0–1.2]) compared with non-MBS groups. Male children had higher weight gain than females. The post-MBS-sleeve but not the post-MBS-bypass offspring had higher BMI z scores.

Conclusions

The higher early-life weight gain and sex differences in the post-MBS-sleeve group compared with the post-MBS-bypass group provide a window toward elucidating pathways to mitigate intergenerational metabolic risk transfer.