http://www.gastroendonews.com/Web-O...-Face-Increased-Risks/39031/ses=ogst?enl=true "However, these risks to the newborn are attenuated when more time passes between a woman’s bariatric procedure and the birth of her child. Infants born to women more than four years after surgery, compared with those whose mothers were less than two years out from surgery, had a reduced risk for prematurity (11.8% vs. 17.2%), NICU admission (12.1% vs. 17.7%), and small size for gestational age (9.2% vs. 12.7%)—a risk profile approaching that of the baseline population." This article omitted the very concerning effects of pregnancy while in ketosis: BMC Pregnancy Childbirth. 2013 May 8;13:109. doi: 10.1186/1471-2393-13-109. Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. Sussman D1, van Eede M, Wong MD, Adamson SL, Henkelman M. Author information Abstract BACKGROUND: The increasing use of the ketogenic diet (KD), particularly by women of child-bearing age, raises a question about its suitability during gestation. To date, no studies have thoroughly investigated the direct implications of a gestational ketogenic diet on embryonic development. METHODS: To fill this knowledge gap we imaged CD-1 mouse embryos whose mothers were fed either a Standard Diet (SD) or a KD 30 days prior to, as well as during gestation. Images were collected at embryonic days (E) 13.5 using Optical Projection Tomography (OPT) and at E17.5 using Magnetic Resonance Imaging (MRI). RESULTS: An anatomical comparison of the SD and KD embryos revealed that at E13.5 the average KD embryo was volumetrically larger, possessed a relatively larger heart but smaller brain, and had a smaller pharynx, cervical spinal cord, hypothalamus, midbrain, and pons, compared with the average SD embryo. At E17.5 the KD embryo was found to be volumetrically smaller with a relatively smaller heart and thymus, but with enlarged cervical spine, thalamus, midbrain and pons. CONCLUSION: A ketogenic diet during gestation results in alterations in embryonic organ growth. Such alterations may be associated with organ dysfunction and potentially behavioral changes in postnatal life. I wish they had ALSO addressed the fact that the babies of women who have them after bariatric surgery (assuming they waited a decent amount of time): http://www.cbsnews.com/news/moms-who-had-weight-loss-surgery-may-pass-on-healthier-genes/ Differential methylation in glucoregulatory genes of offspring born before vs. after maternal gastrointestinal bypass surgery Frédéric Guénarda, Yves Deshaiesb,c, Katherine Cianfloneb,c, John G. Krald, Picard Marceauc,e, and Marie-Claude Vohla,1 Edited by C. Ronald Kahn, Joslin Diabetes Center, Harvard Medical School, Boston, MA, and approved April 30, 2013 (received for review October 10, 2012) Abstract Obesity and overnutrition during pregnancy affect fetal programming of adult disease. Children born after maternal bariatric gastrointestinal bypass surgery (AMS) are less obese and exhibit improved cardiometabolic risk profiles carried into adulthood compared with siblings born before maternal surgery (BMS). This study was designed to analyze the impact of maternal weight loss surgery on methylation levels of genes involved in cardiometabolic pathways in BMS and AMS offspring. Differential methylation analysis between a sibling cohort of 25 BMS and 25 AMS (2–25 y-old) offspring from 20 mothers was conducted to identify biological functions and pathways potentially involved in the improved cardiometabolic profile found in AMS compared with BMS offspring. Links between gene methylation and expression levels were assessed by correlating genomic findings with plasma markers of insulin resistance (fasting insulin and homeostatic model of insulin resistance). A total of 5,698 genes were differentially methylated between BMS and AMS siblings, exhibiting a preponderance of glucoregulatory, inflammatory, and vascular disease genes. Statistically significant correlations between gene methylation levels and gene expression and plasma markers of insulin resistance were consistent with metabolic improvements in AMS offspring, reflected in genes involved in diabetes-related cardiometabolic pathways. This unique clinical study demonstrates that effective treatment of a maternal phenotype is durably detectable in the methylome and transcriptome of subsequent offspring.