Pregnancy After Metabolic Bariatric Surgery: Risks and Rewards for Mother and Child

(BJOG. 2025;132:401-413. doi: 10.1111/1471-0528.18032) Obesity affects an estimated 650 million adults globally, with the prevalence continuing to increase over time. It is associated with other conditions including dyslipidemia, diabetes, hypertensive disorders, vascular disease, and obstructive sleep apnea, and it is associated with an elevated risk for complications in pregnancy that can include gestational diabetes, preeclampsia, macrosomia, large for gestational age, stillbirth, congenital anomalies, delivery complications, and postnatal infection or depression. Treating obesity is difficult because of its multifactorial nature, and often clinical response to lifestyle changes is low. In light of this, patients often seek other treatments such as metabolic bariatric surgery, and thus, the incidence of pregnancy after such procedures is increasing. This article is a review that addresses the benefits and risks for pregnancy that stem from metabolic bariatric surgery, assesses the current state of evidence, and suggests future directions.