Curbing Obesity from One Generation to Another: the Effects of Bariatric Surgery on the In Utero Environment and Beyond

Abstract

Approximately 250,000 individuals seek bariatric surgery each year in the U.S. for the long-term resolution of obesity-related comorbidities. Greater than 80% of these individuals are women and approximately half are of child-bearing age. Although there are many positive metabolic benefits that are realized through surgical weight loss for both men and women, the various long-term hormonal, molecular, nutrient and epigenetic changes following bariatric surgery have not been evaluated for the surgical recipient or in the context of pregnancy and the offspring. Pregnancy may be a vulnerable period of time for the bariatric surgery recipient and thoughtful consideration of pregnancy management should be taken by health care providers and recipients alike. The purpose of this review is to explore potential etiologies of some of the gestation-specific outcomes for the mother and offspring.

Aromatase Inhibition Eliminates Sexual Receptivity Without Enhancing Weight Gain in Ovariectomized Marmoset Monkeys

“…The implications of these findings for women open up a wealth of opportunities to explore novel, central nervous system–targeted approaches to treating sexual dysfunction in women. In an analogous fashion, the lack of effective weight management for captive NHPs [ 205 , 206 ] and women [ 207 ] has led to successive gains in body weight over recent decades among immature and adult female NHPs and humans alike. The findings presented in this female NHP study suggests that future treatments designed to deliver bioactive estradiol to only the central nervous system, including the hypothalamus [ 119 ], may have potential to alleviate both sexual and metabolic dysfunction.…”

The Legacy of Parental Obesity: Mechanisms of Non-Genetic Transmission and Reversibility

“…Mothers have a close interaction with offspring during pregnancy and early life. Research in humans and mice has made us aware that maternal obesity is directly related to poor offspring health [ 38 ], not only as a consequence of obesity-triggered pregnancy complications [ 39 ], but also as a result of epigenetic changes that are stable throughout generations. Indeed, several studies have shown that maternal obesity or increased fat intake induce transcriptional reprogramming [ 40 ], histone modifications [ 41 , 42 ], and DNA methylation changes in offspring [ 43 , 44 , 45 , 46 ].…”

“…In addition to common lifestyle interventions, the more severe forms of obesity are now treated by bariatric surgery, which is becoming increasingly common. Reported evidence based on studies of humans suggests that bariatric surgery is associated with both positive and negative pregnancy and neonatal outcomes [ 39 , 175 , 176 ]. These findings have been corroborated by studies in diet-induced obesity rats, where ventral sleeve gastrectomy has led to worsened pregnancies and offspring health [ 177 , 178 , 179 ].…”

“…Given that a change in diet long before pregnancy has positive effects in offspring, it is possible that women should wait after surgery before becoming pregnant and establish a healthy diet following the surgical procedure. Although it is recommended that women wait 12 to 18 months after the surgery, there is no clear data supporting the benefit of such a wait [ 39 , 175 ].…”

Surgery for fertility? Are there possible surgical options in Polycystic Ovary Syndrome

“…Obese women need higher doses of gonadotropins for ovulation induction during IVF procedures (17). Obesity has an impact on gestation by increasing comorbidities associated with pregnancy: gestational diabetes mellitus, gestational hypertension, eclampsia, increased risk for maternal or fetal death, preterm delivery, intrauterine growth restriction and need for cesarian section (18).…”