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Endothelial function and its determinants in children born after maternal bariatric surgery



Children born from mothers who underwent bariatric surgery were found to have an improved lipid profile and lower CRP levels compared to siblings born before surgery. We hypothesized that surgery before pregnancy might also influence endothelial function in the offspring.


Blood sample analysis, blood pressure (BP) measurement, and peripheral arterial tonometry (PAT) were performed in 142 children (median age 10.5 years), either born from mothers who underwent bariatric surgery (BS) before pregnancy (n = 36) from mothers with overweight/obesity (OW/OB) (n = 71) or from normal weight (NW) mothers (n = 35), allowing the determination of the Reactive Hyperemia Index (RHI) in 111 children.


Children of the BS group had a higher diastolic blood pressure SDS and a lower RHI compared to the children of the OW/OB and NW group (1.32 versus 1.37 in OW/OB and 1.70 in NW; p = 0.004). After log transformation and correction for age, weight SDS, BMI SDS, body fat percentage, and diastolic BP SDS, RHI was comparable between the groups.


Children of mothers who underwent bariatric surgery before pregnancy do not have a disturbed endothelial function before puberty, when their increased diastolic BP and degree of adiposity is taken into account.


  • Children born after maternal bariatric surgery have a higher diastolic blood pressure without impaired endothelial function.

  • To our knowledge, this is the first study that investigates the vascular function of children based on maternal characteristics during pregnancy.

  • Adult offspring of mothers with obesity during pregnancy have an increased cardiovascular mortality. Since we cannot demonstrate a childhood-onset primary vascular dysfunction, this cardiovascular vulnerability might be more related to the hypertension and body adiposity. Thus, more emphasis should be made on the prevention of obesity and hypertension in the offspring at risk for development of obesity.

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Fig. 1: Inclusion flow chart.
Fig. 2: Comparison of Reactive Hyperemia Index (RHI) based on maternal characteristics.


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The research activities of K.VDM. are funded by a doctoral research grant from the Belgian Society for Paediatric Endocrinology and Diabetology (BESPEED) and additional research funding from Wetenschappelijk Fonds Willy Gepts of the UZ Brussel. R.D. is a recipient of a fundamental clinical researcher’s grant, 1803311N, of the “Fonds Wetenschappelijk Onderzoek” (Flemish Research Foundation), Flanders, Belgium.

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K.V.D.M., R.D., and I.G. designed the study and conceptualized the study protocol. Data acquisition was performed by K.V.D.M. K.V.D.M. drafted the initial blueprint, which was reviewed extensively for content and methods by all other contributing authors. All authors approved the final version of the manuscript as submitted for publication.

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Correspondence to Karolien Van De Maele.

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Van De Maele, K., Devlieger, R., De Schepper, J. et al. Endothelial function and its determinants in children born after maternal bariatric surgery. Pediatr Res 91, 699–704 (2022).

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