Pregnancy and birth complications among women undergoing bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass

Background: Metabolic bariatric surgery is the most effective therapy for severe obesity, which affects the health of millions, most of whom are women of child-bearing age. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most common bariatric procedures and are associated with durable weight loss and comorbidity resolution. Although obstetric outcomes broadly improve, the safety profile comparing the impact of RYGB and SG on obstetric outcomes is underexplored. Objectives: To compare obstetric outcomes in women who gave birth post-RYGB versus SG to determine whether there are differences in perinatal outcomes. Setting: United States, all patients within commercial, Medicare, Medicaid, government, and cash payor systems. Methods: The PearlDiver-Mariner database was used to identify women aged 18-52 years who underwent RYGB or SG between 2010 and 2020 and became pregnant within 2 years of surgery. Outcomes were defined by the presence of 1 or more pregnancy-related complications including gestational diabetes, preeclampsia, and hysterectomy. A 1:1 propensity-matched analysis was performed. Results: In total, 16,911 individuals, 10,675 (63.1%) and 6236 (36.9%) underwent SG and RYGB, respectively. Obstetric complication rates were 28.3% in the SG versus 32.1% in the RYGB group (P <.01). The RYGB group had an increased relative odds of experiencing an obstetric complication compared with the SG group (odds ratio 1.26; 95% confidence interval 1.14-1.38). Conclusions: Although both are safe, RYGB was associated with a greater obstetric complication rate than SG. These findings can help women and surgeons decide which procedure to pursue and inform discussions regarding the timing of pregnancy after surgery. (Surg Obes Relat Dis 2025;21:509-515.) (c) 2025 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.