The use of bariatric surgery has risen subsequently over the last decade, especially in women of reproductive age. (Unplanned) pregnancies in this subgroup are not rare because of e.g. an increased fertility (because of the weight loss) and a possible ineffectiveness of contraceptives (because of a malabsorption in the intestine). Although a pregnancy after bariatric surgery is generally known as safe, there are a few studies that indicate that a pregnancy after a bariatric surgery is not always without complications, and that it should be considered as a high risk pregnancy. The research on pregnancy outcomes after this type of surgery is rather limited to a few small, mainly retrospective, observational case-control and cohort studies and a limited amount of case studies. For risk- and prognose related issues, e.g. the effect of bariatric surgery on fertility, timing of the pregnancy, development of complications during the pregnancy and pregnancy outcomes, large prospective cohort studies are needed. Besides, breast feeding practices and breast milk composition have scarcely been investigated in this population. The energy content of breast milk could possibly be influenced by a state of malabsorption after the procedure. Low amounts of vitamin B12 have also been noticed in the breast milk of women the surgery. The overall objective of this study is to establish a group of women at reproductive age (age 18-45) with a history of bariatric surgery and to generate an extensive database for future analysis. The final goal of the researchers is to develop guidelines or recommendations on how to manage pregnancies after bariatric surgery, based on large-scale prospective research. The study design is a multicentric observational and prospective cohort study. Participants will be followed from the moment of surgery until 6 months postpartum and they can be included on several time points (before surgery, after surgery (\<12 months); after surgery (\>12 months) or during the pregnancy). Both retrospective and prospective data concerning the medical background, fertility (menstrual cycle), lifestyle (e.a. food, physical activities, smoking, sleeping), blood samples, psychological factors (fear and depression), sexuality, quality of life and pregnancy outcomes will be collected. Data collection by the investigators will happen in a web-based database and by direct online registration by the subjects.
Women will be included in one of the following four inclusion moments (IM): * Before surgery (women of reproductive age with morbid obesity) (IM1) * After surgery and not being pregnant (IM2) * Before 15 weeks of gestation (IM3) * Day 3 of 4 of the postpartum for breast milk analyses (IM4) Inclusion and exclusion criteria: 1. IM1 Inclusion criteria: * Women * Age between 18 and 45 years * planning bariatric surgery Exclusion criteria: \- Infertile (eg, hysterectomy, menopause, etc.) 2. IM2 Inclusion criteria: * Women * Age between 18 and 45 years * A bariatric surgery in the past Exclusion criteria: \- Infertile (eg, hysterectomy, menopause, etc.) 3. IM3 Inclusion criteria: * Women * Age between 18 and 45 years * A bariatric surgery in the past * \<15 weeks pregnant Exclusion criteria: \- Recruitment after 15 weeks of gestation 4. IM4 Inclusion criteria: * Women * Age between 18 and 45 years * A bariatric surgery in the past * Gestational age between 37 and 42 weeks * Giving birth of a viable child (singleton) * Breastfeeding on day 3 of the postpartum Exclusion criteria: * Intake of the following drugs during lactation: psychotropic drugs, cytotoxic drugs, beta-blockers, dopamine agonists, aspirin, antihistamines, ergotamine, lithium, phenindione, barbiturates, anticonvulsants and sulfasalazine * Diabetes mellitus or diabetes mellitus gravidarum * Newborn admitted to the NICU (no rooming-in) * Uncertainty if milk production is sufficient to meet the needs of the baby (in consultation with the midwife)