In Reply We agree with Dr Auger and colleagues that there are several effects of gastric bypass surgery that may influence the risk of birth defects, including positive effects from weight loss and improved glucose control, as well as negative effects such as nutrient deficiencies and increased risk of substance abuse.¹

With our study design, matching controls and gastric bypass surgery–exposed women on presurgery data regarding BMI, diabetes, and substance abuse, we attempted to answer the research question of whether gastric bypass surgery (vs no surgery) influences the risk of offspring birth defects.² It aimed to inform women with severe obesity, prior to surgical intervention, about the risk or benefit for postsurgery pregnancy and childbirth. Hence, we estimated the net effect from both positive and negative consequences of treatment.

在答复中，我们同意Auger博士及其同事的观点，即胃搭桥手术的多种影响可能会影响出生缺陷的风险，包括减肥和改善血糖控制的积极影响，以及营养缺乏和风险增加等负面影响。滥用。^1个

通过我们的研究设计，匹配的对照和胃旁路手术，使妇女接受有关BMI，糖尿病和药物滥用的术前数据，我们试图回答有关胃旁路手术（相对于无手术）是否影响后代出生缺陷风险的研究问题。²它的目的是在进行外科手术之前告知患有严重肥胖症的妇女有关术后妊娠和分娩的风险或益处。因此，我们从治疗的积极和消极后果估计了净效应。