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| History of preexisting comorbidities such as diabetes mellitus, retinopathy, nephropathy, neuropathy, or hypertension |
| Regular follow-up visits after bariatric surgery are recommended when planning a pregnancy: |
| (i) Nutritional counselling and monitoring of food intake, and exclusion of acute nutritional deficiencies |
| (ii) Half-yearly internal medicine and nutritional controls until two years postsurgical, thereafter 12-month intervals |
| (iii) Gynaecological/obstetric provision is strongly recommended |
| (iv) In case of nutritional deficiencies, controls have to be intensified, especially when pregnancy is planned |
| (v) Surgical controls if necessary or any complications occur (as well as recommended three months after surgery) |
| Pregnancy control interval: |
| (i) Obstetric examination at regular intervals at least every 4–6 weeks with control of weight, urine, and blood pressure, and narrower control intervals if complications occur, decided on individual basis |
| (ii) Regular fetal growth control (check for SGA and LGA) every 4–6 weeks starting from 24th week of pregnancy. Further Doppler ultrasound examinations might be necessary |
| (iii) Internal medicine and nutritional controls every trimester |
| (iv) Explore nutrient uptake, and check full blood count, clinical chemistry, coagulation, vitamins A, D, E, K, B12, iron status, folic acid, parathyroid hormone and protein, albumin, A1c, glucose, and TSH at least every trimester |
| (v) Additional laboratory controls if possible: thiamine and zinc |
| (vi) If necessary, closer intervals have to be considered on an individual basis (2–4 weeks in case of deficiencies, which need to be corrected). |
| Immediate contact with an experienced surgeon in case of unexpected symptoms (especially gastrointestinal) |
| Immediate consultation in case of emergencies: |
| (i) Acute persistent abdominal pain → consult: gynaecologist/obstetrician and surgeon |
| (ii) Persistent vomiting (consider thiamine deficiency; see below sections) → consult gynaecologist/obstetrician, internal specialist, and surgeon |
| A close interdisciplinary cooperation is highly necessary to provide optimal pregnancy outcomes |
| Specialized centres with experience in the care of pregnant women after bariatric surgery need to be contacted or should fully take care of pregnancies after bariatric surgery |
| Drugs not allowed in pregnancy should be discontinued before pregnancy if possible or switched to drugs allowed in pregnancy (e.g., ACE inhibitors, statins, several glucose-lowering drugs). If this is not possible, risk assessment has to be performed in agreement with the patient |
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