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Poster Session 2

Category: Epidemiology

Poster Session 2

(473) Effect of Pre-conception Bariatric Surgery on Attention-deficit Hyperactivity Disorder: Role of Child’s Sex and Race/Ethnicity

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Darios Getahun, MD, MPH, PhD (he/him/his)

Research Investigator II MD
Department of Research & Evaluation, Kaiser Permanente Southern California
Pasadena, California, United States

Coauthor(s)

MF

Michael J. Fassett, MD

Regional Chief, Maternal-Fetal Medicine
Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center
Los Angeles, California, United States
TI

Theresa M. Im, MPH

Senior Research Project Manager
Department of Research & Evaluation, Kaiser Permanente Southern California
Pasadena, California, United States
VC

Vicki Y. Chiu, MS

Biostatistician
Department of Research & Evaluation, Kaiser Permanente Southern California
Pasadena, California, United States
MP

Morgan R. Peltier, PhD

Psychiatry and Behavioral Health, Jersey Shore University Medical Center
Neptune City, New Jersey, United States

Objective:
Although bariatric surgery (BS) may deprive the fetus of essential nutrients, affecting growth and development, its link to attention deficit hyperactivity disorder (ADHD) risk has received limited attention. We investigated whether preconception BS increases ADHD risk and how gestational age, child’s sex, and race/ethnicity may modify this association.

Study Design:
We conducted a retrospective cohort study of children born between 2011–2022 at Kaiser Permanente Southern California (KPSC) hospitals. BS data were obtained from the KPSC Bariatric Surgery Registry (n = 17,254). ADHD diagnoses were made by neurodevelopmental specialists using standardized protocols and validated against gold standards. We assessed the modifying effects of BS type, child’s sex, race/ethnicity, and gestational age. Associations between BS and ADHD were evaluated using Cox proportional hazards models, reported as incidence rates and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs).

Results:
Children of mothers with preconception BS had higher ASD rates than those without BS (8.3% vs. 6.1%; aHR = 1.52, CI: 1.22–1.90). The association was significant for pregnancies conceived < 1 year (aHR 1.59, CI: 1.16–2.17), 1–2 years (aHR 1.48, CI: 1.11–1.97), and ≥2 years (aHR 1.33, CI: 1.08–1.63) post-surgery. It was significant among Hispanic (aHR 1.67, CI: 1.24–2.27), but not for non-Hispanic groups, and for Roux-en-Y gastric bypass (aHR 1.43, CI: 1.12–1.82) and sleeve (aHR 1.48, CI: 1.20–1.82) procedures. Stratified analyses showed higher ADHD risk in children of mothers with post-surgery body mass index (BMI) 35–39.9 kg/m², compared to BMI-matched women without BS. The BS - ADHD link was consistent across race/ethnicity and sex.

Conclusion:
Preconception BS increases the risk of ADHD in offspring, regardless of the interval between surgery and pregnancy, as well as the child’s sex and race/ethnicity.