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Pharmacological interventions for weight loss before conception—putative effects on subsequent gestational weight gain should be considered

International Journal of Obesity volume 47, pages 335–337 (2023)Cite this article

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Obesity is a well-known risk factor for adverse pregnancy outcomes. It increases the risk of pregnancy complications such as gestational diabetes, hypertension or preeclampsia and also the risk of complications during delivery and adverse outcomes for the offspring such as large for gestational age babies, congenital malformations and even stillbirths [1]. Furthermore, maternal obesity also adversely affects long-term metabolic health of the offspring through foetal programming [2]. Finally, obesity can impair fertility preventing many women to get pregnant. If successfully treated, previous infertility also represents an independent risk factor for adverse gestational outcomes. On this background, weight loss before conception is widely recommended to improve fertility as well as gestational and offspring outcomes. Of note, however, the maintenance of weight loss, i.e., keeping the weight at the reduced levels over a longer period of time, is even much harder to achieve than weight loss per se. This is one of the reasons why obesity is a chronic, relapsing disease. With this in mind, the aspect of weight loss maintenance should be taken into account when planning a weight loss intervention in women with obesity or overweight who might get pregnant in the future since the extent of weight gain or weight regain during pregnancy also impacts gestational and offspring outcomes.

Weight loss can be achieved by behavioral lifestyle interventions aiming to improve dietary habits and increase physical activity, but the effectiveness of such interventions is often limited, also due to neuroendocrine counterregulatory responses. This results in an only moderate weight loss in a limited number of women with obesity [3]. A greater amount of weight loss before conception can be achieved by bariatric surgery. While overall bariatric surgery appears to reduce the risk of obesity-related gestational complications, it was also found to be associated with an increased risk of small for gestational age babies as well as more frequent respiratory failures associated with bronchiolitis in infants. Moreover, women who have undergone bariatric surgery before pregnancy require continuous nutritional support including a regular intake of micronutrient supplements [4].

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Fig. 1: Schematic illustration of hypothetical body weight trajectory (upper panel) and concurrent energy balance (deficit and excess) during various weight loss interventions before conception: no intervention, behavioral intervention, bariatric surgery, and anti-obesity drug therapy, as well as the subsequent pregnancy.

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Authors and Affiliations

  1. Metabolic Center St. Gallen, friendlyDocs Ltd, St. Gallen, Switzerland

    Bernd Schultes & Barbara Ernst

  2. Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland

    Katharina Timper

  3. Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Jardena Puder

  4. Privat Practice for Endocrinology, Diabetes, and Obesity, Olten, Switzerland

    Gottfried Rudofsky

Authors
  1. Bernd Schultes
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  2. Barbara Ernst
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  3. Katharina Timper
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  4. Jardena Puder
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  5. Gottfried Rudofsky
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Contributions

Conceiving the work that led to the submission: BS, BE, KT, JP, GR. Drafting the paper: BS, BE, KT, JP, GR. Revising paper: BS, BE, JP, KT. All authors read and approved the final version of the paper.

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Correspondence to Bernd Schultes.

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Competing interests

Dr BS has received presentation fees from and compensation as a member of a scientific advisory board of Novo Nordisk and Eli Lilly as well as for serving as a study investigator for Novo Nordisk. Dr BE has nothing to declare. Dr KT has received presentation fees from and compensation as a member of a scientific advisory board of Novo Nordisk. She also received a restricted research grant from Novo Nordisk. Dr JP has received compensation as a member of a scientific advisory board of Eli Lilly and received a unrestricted educational grant from Novo Nordisk. Dr GR has received presentation fees from and compensation as a member of a scientific advisory board of Novo Nordisk and Eli Lilly as well as for serving as a study investigator for Novo Nordisk.

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Schultes, B., Ernst, B., Timper, K. et al. Pharmacological interventions for weight loss before conception—putative effects on subsequent gestational weight gain should be considered. Int J Obes 47, 335–337 (2023). https://doi.org/10.1038/s41366-023-01276-7

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